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Social determinants of health among residential areas with a high tuberculosis incidence in a remote Inuit community
  1. Elaine Kilabuk1,
  2. Franco Momoli2,3,4,
  3. Ranjeeta Mallick2,
  4. Deborah Van Dyk2,
  5. Christopher Pease3,5,
  6. Alice Zwerling3,
  7. Sharon Edmunds Potvin6,
  8. Gonzalo G Alvarez2,3,5
  1. 1 Department of Internal Medicine, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
  2. 2 Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
  3. 3 School of Public Health, University of Ottawa, Ottawa, Ontario, Canada
  4. 4 Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
  5. 5 The Ottawa Hospital, Division of Respirology, Department of Medicine, Ottawa, Ontario, Canada
  6. 6 Nunavut Tunngavik Inc, Iqaluit, Nunavut, Canada
  1. Correspondence to Dr Gonzalo G Alvarez, Division of Respirology, Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada; galvarez{at}


Background Tuberculosis (TB) remains a significant health burden among Inuit in Canada. Social determinants of health (SDH) play a key role in TB infection, disease and ongoing transmission in this population. The objective of this research was to estimate the prevalence of social determinants of Inuit health as they relate to latent TB infection (LTBI) among people living in residential areas at high risk for TB in Iqaluit, Nunavut.

Methods Inperson home surveys were conducted among those who lived in predetermined residential areas at high risk for TB identified in a door-to-door TB prevention campaign in Iqaluit, Nunavut in 2011. Risk ratios for SDH and LTBI were estimated, and multiple imputation was used to address missing data.

Results 261 participants completed the questionnaire. Most participants identified as Inuit (82%). Unadjusted risk ratios demonstrated that age, education, smoking tobacco, crowded housing conditions and Inuit ethnicity were associated with LTBI. After adjusting for other SDH, multivariable analysis showed an association between LTBI with increasing age (relative risk, RR 1.07, 95% CI 1.04 to 1.11), crowded housing (RR 1.48, 95% CI 1.10 to 2.00) and ethnicity (RR 2.76, 95% CI 1.33 to 5.73) after imputing missing data.

Conclusion Among high-risk residential areas for TB in a remote Arctic region of Canada, crowded housing and Inuit ethnicity were associated with LTBI after adjusting for other SDH. In addition to strong screening and treatment programmes, alleviating the chronic housing shortage will be a key element in the elimination of TB in the Canadian Inuit Nunangat.

  • tuberculosis
  • social inequalities
  • ethnicity

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  • Contributors EK, DVD, SEP and GGA conceived the study. All authors evaluated the data. All authors reviewed the draft, had critical input and reviewed the final submission.

  • Funding Public Health Agency of Canada, The National Lung Health Framework.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval The study was approved by the Ottawa Hospital Research Institute Ethics Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.