HomeData from 2000-2004 show especially high proportions (about 60%) of individuals with active TB disease lost to follow up, and so the treatment outcome data for this period are limited (Figure 12). Improved follow-up since 2004 has resulted in outcome data being obtained for 90.0% or more of individuals diagnosed with active TB disease in recent years. The proportion with successful active TB disease treatment has consistently been above 90% (Table 7).
Table 7. Outcome of active TB disease treatment in Canada over the years, CTBRS: 2000-2019.
| 2000-2003 n (%) |
2004-2007 n (%) |
2008-2011 n (%) |
2012-2015 n (%) |
2016-2019 n (%) |
|
|---|---|---|---|---|---|
| Treatment success | 2,345 (92.3) | 4,029 (91.9) | 5,432 (91.9) | 5,536 (90.4) | 5,876 (90.3) |
| Treatment changed due to initial failure | 2 (0.1) | 2 (0.0) | 4 (0.1) | 2 (0.0) | 0 (0.0) |
| Treatment discontinued | 0 (0.0) | 0 (0.0) | 16 t(0.3) | 30 (0.5) | 11 (0.2) |
| Treatment Ongoing a | 1 (0.0) | 76 (1.7) | 98 (1.7) | 198 (3.2) | 270 (4.2) |
| Death due to TB | 192 (7.6) | 279 (6.4) | 363 (6.1) | 359 (5.9) | 348 (5.3) |
| Subtotal of cases with outcome | 2,540 (100) | 4,386 (100) | 5,913 (100) | 6,125 (100) | 6,505 (100) |
| Lost to Follow up | 4,154 | 1,920 | 420 | 324 | 637 |
aThe CTBRS currently does not have follow-up of individuals under treatment beyond each surveillance year; hence these treatment outcomes are unknown.
Abbreviations: TB, tuberculosis; CTBRS, Canadian TB Reporting System.
2.6.1. TB-Related mortality
Reported TB-related deaths (ie, TB disease was either a direct cause of, or a contributing factor to, the death) increased by about 42% from 2000-2003 to 2004-2007, and by 35% from 2004-2007 to 2008-2011. Since 2011, TB-related mortality has been stable (Table 8). This increase in the two earlier periods was in part a reporting issue, since data before 2008 were significantly impacted by the relatively high proportion of individuals under treatment for active TB disease who were lost to follow-up (Figure 12).
Table 8. Summary of TB-related deaths in different population subgroups, CTBRS: 2000-2019.
| 2000-2003 n (%) |
2004-2007 n (%) |
2008-2011 n (%) |
2012-2015 n (%) |
2016-2019 n (%) |
||
|---|---|---|---|---|---|---|
| TB-related mortalities | Canadian Indigenous | 74 (41.8) | 61 (24.3) | 71 (21.0) | 53 (16.0) | 32 (10.1) |
| Canadian non-Indigenous | 29 (16.4) | 43 (17.1) | 80 (23.7) | 43 (13.0) | 46 (14.6) | |
| Foreign-born | 74 (41.8) | 147 (58.6) | 187 (55.3) | 236 (71.1) | 238 (75.3) | |
| Overall | 177 (100) | 251 (100) | 338 (100) | 332 (100) | 316 (100) |
Abbreviations: TB, tuberculosis; CTBRS, Canadian TB Reporting System.
2.6.1.1. TB-related mortality in Indigenous peoples.
The majority of TB-related deaths in Indigenous peoples in Canada were among First Nations peoples and mostly among those aged 35 years and older (Figure 13A). The total numbers of deaths among the Inuit and Métis populations in each age group were significantly lower than those recorded among First Nations in general (Figures 13B-13C).
2.6.1.2. TB-related mortality in Canadian-born, non- Indigenous populations.
In terms of numbers, the Canadian-born, non-Indigenous population has consistently recorded the lowest TB-related mortality compared to other population subgroups. In the last 20 years, an average of 12 TB-related deaths per year were reported for this population (Table 8). The corresponding TB case-fatality rate, however, has generally been higher compared to both the Canadian- born Indigenous and foreign-born populations since 2007 (Figure 14, upper panel). Within the Indigenous sub-populations, the TB case-fatality rate has generally been lowest among the Inuit (Figure 14, lower panel).
The majority of deaths in Canadian-born, non-Indigenous populations was among those aged 65 years or older, with more than twice as many deaths in this age group compared to the 35-64 age group over the time period (Figure 15). The lowest mortality has been among children (aged 0-14 years of age), with only three deaths in total over the past 2 decades (Figure 15).
2.6.1.3. TB-related mortality in foreign-born populations.
The majority of TB-related deaths among foreign-born individuals in the last 2 decades in Canada occurred among older individuals, aged 65 years or older, who were born in the Western Pacific and South-East Asia regions (Figures 16E and 16F), which reflects the high TB burden observed in individuals coming from these 2 regions (Table 6). The lowest annual TB mortality among foreign-born individuals has been consistently found among individuals born in the European, African, Eastern Mediterranean and Americas regions (Figures 16A-16D).
The case-fatality rate in foreign-born individuals has been variable, ranging from a low of 0.9% in 2003 to a high of 6.5% in 2015. After remaining stable at around 5.0% from 2016 to 2018, it dropped to 3.5% in 2019 (Figure 14, upper panel).
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