Syrian civil war and assessment of tuberculosis among Syrian refugees and local citizens in Mardin

Background We compared tuberculosis (TB) characteristics and outcomes between Syrian refugees and local citizens in Mardin, Turkey (2016-2023), a border province with substantial population mobility. Methods Retrospective, registry-based cross-sectional analysis of 491 patients (locals n = 456; refugees n = 35). Descriptive comparisons used χ 2 /Fisher (categorical) and Mann-Whitney U (age). Annual incidence per 100,000 used mid-year denominators (locals: ABPRS/NVI; refugees: DGMM/PMM and UNHCR). For outcomes with significant crude differences (treatment success, BCG scar, transferred-out), age- and sex-adjusted bias-reduced (Firth) logistic regression was applied; p -values from penalized likelihood-ratio (PLR) tests. Results BCG-scar positivity was lower in refugees than locals (62.9% vs. 93.2%, p p = 0.03), while transferred-out was higher (25.7% vs. 5.3%, p = 0.001). In adjusted Firth models including all cases, refugee status was associated with lower odds of success (aOR 0.224, 95% CI 0.103-0.488; PLR p p = 0.42). In pulmonary-only analyses, the association persisted (aOR 0.216, 95% CI 0.083-0.567; PLR p = 0.002). Refugee incidence dipped in 2020-2021 and rebounded in 2022-2023. Conclusion Differences likely reflect operational barriers-especially transfers disrupting continuity-rather than intrinsic factors. Refugee-inclusive TB services with robust inter-provincial transfer tracking, patient navigation, and expanded bacteriological testing (notably for extrapulmonary disease) should be prioritized. Given the small refugee subgroup and denominator uncertainties, findings are hypothesis-generating.