TUBERCULOSIS MORTALITY IN NOTIFIED CASES FROM 1989-1995 IN BIRMINGHAM

This is a retrospective descriptive study examining medical records of notified cases of tuberculosis in Birmingham, UK, who died before com pletion of treatment, plus notified cases identified at postmortem. Du ring the study period, 1989-1995, there were a total of 2088 notificat ions of tuberculosis of which 75 (3.6%) died. This case-fatality rate is lower than that reported from earlier studies, a finding which may be due to improved ascertainment, earlier diagnosis and improved treat ment in recent years. Forty-five deaths (60%) were in males and 30 (40 %) in females. The median age at death was 66 y. Forty-five deaths (60 %) were among the white ethnic group, 21 (28%) among persons of Indian sub-continent origin, 4 (5.3%) among Black Caribbeans and 5 (6.6%) am ong the other ethnic groups. Case-fatality rates were significantly hi gher (P < 0.01) in caucasians (9.4%) than in Asians (1.5%) and only ha lf of this difference was explained by the age of those affected. Twen ty-two (29%) cases were confirmed by a positive sputum smear and a fur ther 23 (31%) by a positive sputum culture. Eighteen (24%) cases also had histological confirmation. Twelve (16%) cases were identified on a utopsy. The case fatality rate in respiratory disease was significantl y higher (RR = 1.19, P > 0.05) than in non-respiratory disease. As del ay in diagnosis is likely to be the main contributing factor leading t o death, a high index of suspicion of tuberculosis is needed when inve stigating elderly patients with general chronic illness, especially if there are prolonged respiratory symptoms. Early diagnosis will reduce mortality as the disease rapidly responds to treatment.