       Document 0154
 DOCN  M9580154
 TI    Increasing incidence of tuberculosis in England and Wales: a study of
       the likely causes [see comments]
 DT    9506
 AU    Bhatti N; Law MR; Morris JK; Halliday R; Moore-Gillon J; Department of
       Public Health, East London and City District Health; Authority.
 SO    BMJ. 1995 Apr 15;310(6985):967-9. Unique Identifier : AIDSLINE
       MED/95245190
 CM    Comment in: BMJ 1995 Apr 15;310(6985):954-5
 AB    OBJECTIVE--To examine factors responsible for the recent increase in
       tuberculosis in England and Wales. DESIGN--Study of the incidence of
       tuberculosis (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) England and Wales 1980-92, and (b) the London borough of
       Hackney 1986-93. MAIN OUTCOME MEASURE--Age and sex adjusted rate of
       tuberculosis. RESULTS--In England and Wales notifications of
       tuberculosis increased by 12% 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% from 1986-8 (78 cases) to 1991-3 (123), whereas in
       residents of Indian subcontinent origin the increase was 41% (from 51
       cases to 72). Tuberculosis in recently arrived immigrants--refugees (11%
       of the Hackney population) 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 infection, nor to an increase in homeless people.
       CONCLUSIONS--The national rise in tuberculosis affects only the poorest
       areas. Within one such area all residents (white and established ethnic
       minorities) were affected to a similar extent. The evidence indicates a
       major role for socioeconomic factors in the increase in tuberculosis and
       only a minor role for recent immigration from endemic areas.
 DE    Asia/ETHNOLOGY  Crowding  Disease Notification  England/EPIDEMIOLOGY
       Human  Incidence  India/ETHNOLOGY  Poverty Areas  Refugees  Risk Factors
       Tuberculosis/ETHNOLOGY/*EPIDEMIOLOGY  Turkey/ETHNOLOGY
       Wales/EPIDEMIOLOGY  West Indies/ETHNOLOGY  JOURNAL ARTICLE

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).

