INCREASING INCIDENCE OF TUBERCULOSIS IN ENGLAND AND WALES - A STUDY OF THE LIKELY CAUSES

Objective-To examine factors responsible for the recent increase in tu berculosis in England and Wales. Design-Study of the incidence of tube rculosis (a) in the 403 local authority districts in England and Wales , ranked according to Jarman score, and (b) in one deprived inner city district, according to ethnic origin and other factors. Setting-(a) E ngland and Wales 1980-92, and (b) the London borough of Hackney 1986-9 3. Main outcome measure-Age and sex adjusted rate of tuberculosis. Res ults-In England and Wales notifications of tuberculosis increased by 1 2% between 1988 and 1992. The increase was 35% in the poorest 10th of the population and 13% in the next two; and in the remaining 70% there was no increase. In Hackney the increase affected traditionally high risk and low risk ethnic groups to a similar extent. In the ''low risk '' white and West Indian communities the incidence increased by 58% fr om 1986-8 (78 cases) to 1991-3 (123), whereas in residents of Indian s ubcontinent origin the increase was 41% (from 51 cases to 72). Tubercu losis in recently arrived immigrants-refugees (11% of the Hackney popu lation) and Africans (6%)-accounted for less than half of the overall increase, and the proportion of such residents was much higher than in most socioeconomically deprived districts. The local increase was not due to an increase in the proportion of cases notified, to HIV infect ion, nor to an increase in homeless people. Conclusions-The national r ise in tuberculosis affects only the poorest areas. Within one such ar ea all residents (white and established ethnic minorities) were affect ed to a similar extent. The evidence indicates a major role for socioe conomic factors in the increase in tuberculosis and only a minor role for recent immigration from endemic areas.