Home2.3.1. Sex distribution
The overall incidence rate of active TB disease in Canada since 2002 has remained unchanged at about 5.0 individuals per 100,000 population per year (Figure 2). In 2020, 1,772 individuals with active TB disease were reported for a national rate of 4.7 per 100,000. The rate among males has remained higher than that among females, as illustrated in Table 2 and Figure 2, with active TB disease diagnosed 1.1 to 1.4 times more frequently among males compared to females. This is consistent with global TB trends.1
Table 2. Reported number of active TB disease by sex in Canada, CTBRS: 2009-2020.
| 2000-2003 | 2004-2007 | 2009-2012 | 2013-2016 | 2017-2020 | ||||||
| n | (%) | n | (%) | n | (%) | n | (%) | n | (%) | |
| Female | 3,085 | (46.2) | 2,970 | (45.6) | 2,903 | (44.2) | 3,034 | (45.5) | 3,285 | (44.9) |
| Male | 3,597 | (53.8) | 3,540 | (54.4) | 3,658 | (55.8) | 3,637 | (54.5) | 4,024 | (55.1) |
| Total | 6,682 | (100) | 6,510 | (100) | 6,561 | (100) | 6,671 | (100) | 7,309 | (100) |
Information about the sex of five individuals reported between 2017 and 2020 was unavailable. Abbreviations: TB, tuberculosis; CTBRS, Canadian TB reporting system.
Abbreviations: TB, tuberculosis; CTBRS, Canadian TB Reporting System.
2.3.2. Age distribution
The CTBRS data demonstrate that, between 2001 and 2020, individuals 15-64 years of age accounted for the largest number with active TB disease in comparison to other age groups (Table 3). Until 2020, the highest age-specific incidence rate had consistently been found in the 65+ years old age group. In 2020, however, the highest incidence rate was found in the 15-34 years old age group, at 6.3 individuals per 100,000 population (Figure 3). For the last two decades, the lowest annual numbers (and incidence rates) have been among individuals less than 15 years of age (Figure 3).
Table 3. Reported active TB disease by age group in Canada over time, CTBRS: 2001-2020.
| 2001-2004 | 2005-2008 | 2009-2012 | 2013-2016 | 2017-2020 | ||||||
| n | (%) | n | (%) | n | (%) | n | (%) | n | (%) | |
| 0-14 years old | 379 | (5.7) | 410 | (6.3) | 363 | (5.5) | 375 | (5.6) | 404 | (5.5) |
| 15-34 years old | 2,081 | (31.1) | 2,004 | (30.8) | 2,060 | (31.4) | 2,010 | (30.1) | 2,378 | (32.5) |
| 35-64 years old | 2,581 | (38.6) | 2,609 | (40.1) | 2,666 | (40.6) | 2,621 | (39.3) | 2,750 | (37.6) |
| 65+ years old | 1,641 | (24.6) | 1,487 | (22.8) | 1,472 | (22.4) | 1,665 | (25.0) | 1,782 | (24.4) |
| Total | 6,682 | (100) | 6,510 | (100) | 6,561 | (100) | 6,671 | (100) | 7,314 | (100) |
Abbreviations: TB, tuberculosis; CTBRS, Canadian TB reporting system.
2.3.3. Regional distribution
While the northern Canadian territories (Yukon Territory [YT], Northwest Territory [NWT] and Nunavut [NU]) collectively reported the lowest absolute numbers of individuals with active TB disease, they consistently posted the highest annual incidence rate, in part due to their small populations (Table 4 and Figure 4). The variations observed are mainly indicative of the sporadic nature of outbreaks in the territories. The incidence rates in all other regions of Canada have remained unchanged in the past two decades (Figure 4). Western (Manitoba [MB], Saskatchewan [SK], Alberta [AB] and British Columbia [BC]) Canada reported the second-highest active TB disease incidence rates (between 5.6 and 6.4 cases per 100,000 population; Figure 4). The region with the lowest incidence rates has consistently been Atlantic Canada (New Brunswick [NB], Nova Scotia [NS],
Table 4. Reported active TB disease by geographical region in Canada over time, CTBRS: 2001-2020.
| 2001-2004 | 2005-2008 | 2009-2012 | 2013-2016 | 2017-2020 | ||||||
| n | (%) | n | (%) | n | (%) | n | (%) | n | (%) | |
| Northern Territories | 145 | (2.2) | 243 | (3.9) | 366 | (5.8) | 259 | (4.0) | 278 | (3.9) |
| Atlantic Canada | 124 | (1.9) | 84 | (1.3) | 114 | (1.8) | 137 | (2.1) | 142 | (2.0) |
| Western Canada | 2,581 | (38.6) | 2,639 | (41.8) | 41.8 | (41.8) | 2,875 | (44.6) | 3,120 | (43.7) |
| Central Canada | 3,832 | (57.2) | 3,544 | (56.2) | 3,442 | (54.4) | 3,400 | (52.7) | 3,774 | (52.8) |
| Total | 6,682 | (100) | 6,510 | (100) | 6,561 | (100) | 6,671 | (100) | 7,314 | (100) |
Abbreviations: TB, tuberculosis; CTBRS, Canadian TB reporting system.
Prince Edward Island [PEI] and Newfoundland [NL]), which has recorded an annual rate of 0.8 to 1.4 per 100,000 population since 2001 (Figure 4). Although there has been an increase in the overall number of individuals with active TB disease during the last 4 years, mainly in central and western Canada (Table 4), the incidence rate of active TB disease has remained approximately constant due to corresponding increases in population size.
2.3.4. TB in specific populations
The burden of TB in Canada is not shared equally across the entire population. Foreign-born individuals and Canadian-born Indigenous peoples are disproportionately affected by TB (Figure 5). The former has consistently accounted for the majority of reported cases: between 65% and 67% from 2001 to 2012, and between 70% and 72% from 2013 to 2020, Canadian-born Indigenous peoples, for their part, represented between 14% and 22% of individuals with active TB disease between 2001 and 2020, despite comprising only 4.3% of the Canadian population.2 In Canadian-born, non-Indigenous populations, the incidence rate of active TB disease has been gradually decreasing over the years, from 1.2 cases per 100,000 in 2001 to 0.4 in 2019; in 2020, however, it increased to 1.2 per 100,000 population.
2.3.4.1. TB in Indigenous populations.
While the greatest number of individuals with active TB disease is reported among foreign-born individuals, the incidence rate of active TB disease over the past 2 decades has consistently been highest among some groups of Canadian-born Indigenous peoples (Figure 5), which include First Nations, Métis and Inuit, as per the Constitution Act of 1982.i Social conditions such as over-crowding have played an important role in the TB situation among Indigenous peoples, increasing the risk of infection3 as well as the risk of progression to active TB disease.4,5 The incidence rate of TB among the Inuit has been the highest among these three groups. In 2019, the active TB disease incidence rate among the Inuit (188.7 cases per 100,000 population) was approximately 472 times that of the Canadian-born, non-Indigenous (0.4 cases per 100,000 population) population (Figure 5), but in 2020, it decreased significantly to 70.3 cases per 100,000 population. While the reasons for this decrease are not fully understood, it may be related to public health measures put in place for COVID-19 that resulted in reduced transmission, and/or the pandemic’s impacts on health services access and delivery, leading to under-diagnosis of active TB disease.
Table 5. Reported active TB disease by population subgroup in Canada over time, CTBRS: 2001-2020.
| 2001-2004 | 2005-2008 | 2009-2012 | 2013-2016 | 2017-2020 | ||
| n (%) | n (%) | n (%) | n (%) | n (%) | ||
| Canadian-born | First Nations | 786 (11.8) | 902 (13.9) | 803 (12.2) | 753 (11.3) | 568 (7.8) |
| • On-reserve | 417 (6.2) | 516 (7.9) | 443 (6.8) | 504 (7.6) | 345 (4.7) | |
| • Off-reserve | 269 (4.0) | 339 (5.2) | 295 (4.5) | 222 (3.3) | 166 (2.3) | |
| Inuit | 138 (2.1) | 258 (4.0) | 468 (7.1) | 436 (6.5) | 464 (6.3) | |
| Métis | 135 (2.0) | 123 (1.9) | 83 (1.3) | 59 (0.9) | 59 (0.8) | |
| non-Indigenous | 987 (14.8) | 812 (12.5) | 783 (11.9) | 637 (9.5) | 392 (5.4) | |
| Unknown If Indigenous/not | 0 (0.0) | 0 (0.0) | 0 (0.0) | 34 (0.5) | 160 (2.2) | |
| Foreign-born | 4,476 (67.0) | 4,264 (65.5) | 4,337 (66.1) | 4,672 (70.0) | 5,353 (73.2) | |
| Unknown If Canadian/foreign-born | 161 (2.4) | 151 (2.3) | 87 (1.3) | 80 (1.2) | 318 (4.3) | |
| Total | 6,682 (100) | 6,510 (100) | 6,561 (100) | 6,671 (100) | 7,314 (100) | |
Abbreviations: TB, tuberculosis; CTBRS, Canadian TB Reporting System.
Among First Nations peoples, the incidence rate of active TB disease has been consistently higher among those living on-reserve than those living off-reserve (Table 5 and Figure 5). Incidence rates for First Nations on-reserve were relatively stable from 2001 to 2010, but have been decreasing incrementally since 2015 (Figure 5). Incidence rates among First Nations off-reserve have also been decreasing, and in 2020, they reached a level below the national average of 4.6 per 100,000 population (Figure 5).
Unlike Inuit and First Nations peoples, the reported TB incidence among the Métis is similar to that of the non-Indigenous, Canadian-born population. However, this may partly be influenced by challenges in collecting Métis-specific data and in separating Métis from First Nations individuals when there is shared ancestry.6 Reported incidence rates among Métis populations remained stable from 2000 to 2007, after which they progressively decreased and have been below the national average since 2011 (Figure 5).
2.3.4.2. TB in foreign-born populations.
The total annual number of foreign-born individuals with active TB disease reported to the CTBRS increased noticeably in the last 8 years (Table 6). However, this did not significantly affect the corresponding incidence rate, which has been relatively stable since 2011 (Figure 5).
Foreign-born individuals diagnosed with active TB disease are assigned to a WHO epidemiologic region on the basis of the country of birth. Table 6 depicts changes over time in the number of foreign-born individuals with active TB disease reported in Canada between 2001 and 2020 grouped by their epidemiologic region of birth as per the WHO definition. Associated incidence rates (Figure 6) are calculated using denominators produced by latest census data from Statistics Canada.7
South-East Asia (SEAR) and African regions (AFR) have consistently posted the highest incidence rates of active TB disease among foreign-born individuals for the past two decades (Figure 6), followed by Western Pacific (WPR) and Eastern Mediterranean (EMR) regions. Comparatively, incidence rates have been the lowest among individuals from the European (EUR) and Americas (AMR) regions (Figure 6).
Table 6. Reported active TB disease in foreign-born individuals by WHO birth region, CTBRS: 2001-2020.
| 2001-2004 | 2005-2008 | 2009-2012 | 2013-2016 | 2017-2020 | |
| n (%) | n (%) | n (%) | n (%) | n (%) | |
| AFR | 412 (9.5) | 492 (11.7) | 506 (11.8) | 560 (12.1) | 690 (13.3) |
| AMR | 285 (6.6) | 271 (6.5) | 255 (6.0) | 222 (4.8) | 250 (4.8) |
| EMR | 453 (10.4) | 470 (11.2) | 429 (10.0) | 472 (10.2) | 560 (10.8) |
| EUR | 380 (8.8) | 306 (7.3) | 253 (5.9) | 201 (4.3) | 145 (2.8) |
| SEAR | 972 (22.4) | 983 (23.5) | 1,042 (24.4) | 1,220 (26.3) | 1,534 (29.6) |
| WPR | 1,838 (42.4) | 1,669 (39.8) | 1,786 (41.8) | 1,965 (42.3) | 1,998 (38.6) |
| Overall | 4,340 (100) | 4,191 (100) | 4,271 (100) | 4,640 (100) | 5,177 (100) |
Abbreviations: TB, tuberculosis; WHO, World Health Organisation; CTBRS, Canadian TB Reporting System; AFR, African region; AMR, Americas region; EMR, Eastern Mediterranean region; EUR, European region; SEAR, South East Asian region; WPR, Western Pacific region.
For individuals born outside Canada who were diagnosed with TB disease, the dates of arrival in Canada and active TB disease diagnosis were used to estimate the time lived in Canada until active TB disease diagnosis. Among those foreign-born individuals with active TB disease reported between 2001 and 2020 with known date of arrival, 9.2% were reported within the first year of arrival, 20.2% within the first 2 years of arrival, and 42.0% within the first 5 years, with an additional 15.6% in the subsequent 5 years (Figure 7).
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