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A Population-Based Cohort Study of Mycobacterium tuberculosis Beijing Strains: An Emerging Public Health Threat in an Immigrant-Receiving Country? 1,2 3 1 4,5 2 Deanne Langlois-Klassen *, Dennis Kunimoto , L. Duncan Saunders , Linda Chui , Jody Boffa , Dick Menzies6, Richard Long1,2,3 1 Department of Public Health Sciences, University of Alberta, Edmonton, Canada, 2 Tuberculosis Program Evaluation and Research Unit, University of Alberta, Edmonton, Canada, 3 Department of Medicine, University of Alberta, Edmonton, Canada, 4 Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Canada, 5 Provincial Laboratory for Public Health, Edmonton, Canada, 6 Respiratory Division, McGill University Health Centre and McGill University, Montreal, Canada Abstract Introduction: Mycobacterium tuberculosis Beijing strains are frequently associated with tuberculosis outbreaks and drug resistance. However, contradictory evidence and limited study generalizability make it difficult to foresee if the emergence of Beijing strains in high-income immigrant-receiving countries poses an increased public health threat. The purpose of this study was to determine if Beijing strains are associated with high risk disease presentations relative to other strains within Canada. Methods: This was a retrospective population-based study of culture-confirmed active TB cases in a major immigrant- receiving province of Canada in 1991 through 2007. Of 1,852 eligible cases, 1,826 (99%) were successfully genotyped. Demographic, clinical, and mycobacteriologic surveillance data were combined with molecular diagnostic data. The main outcome measures were sit