TUBERCULOSIS MORTALITY IN ENGLAND AND WALES DURING 1982-1992 - ITS ASSOCIATION WITH POVERTY, ETHNICITY AND AIDS

This paper seeks to establish the strength of association between cont emporary tuberculosis (TB) in England and Wales and several potential aetiological factors. It presents an ecological analysis of standardis ed annual TB mortality rates for the 403 local authority districts bet ween 1982 and 1992, disaggregated by age and sex. Social, demographic and ethnicity measures from the 1981 and 1991 censuses and standardise d annual AIDS-related mortality rates for young men are used to calcul ate Poisson regression models. A strong association was found between all TB mortality groups and overcrowding at the household level. For N omen, no other measures improved the explanatory power of the models. In multiple regressions, both poverty and AIDS-related mortality expla ined additional variation in the model for younger men. The link betwe en ethnicity and tuberculosis notifications was not reflected in this analysis of mortality. For all groups no evidence of a positive relati onship with ethnicity was found, once overcrowding had been accounted for. The significance of household as opposed to district level crowdi ng suggests that prolonged contact is required for disease transmissio n. Regression analysis indicates that it is the overcrowding and pover ty among ethnic populations that is significant for their tuberculosis mortality. The fact that the relationship between AIDS and TB is conf ined to the group most typical of AIDS patients provides evidence that AIDS has little influence on the level of tuberculosis mortality in t he wider population. Explanations for the observed relationship includ e preferential certification, migration for treatment and shortcomings in health care provision. (C) 1998 Elsevier Science Ltd. All rights r eserved.