Abstract
Migrants and ethnic minorities in the UK have higher rates of tuberculosis (TB) compared with the general population. Historically, much of the disparity in incidence between UK-born and migrant populations has been attributed to differential pathogen exposure, due to migration from high-incidence regions and the transnational connections maintained with TB endemic countries of birth or ethnic origin. However, focusing solely on exposure fails to address the relatively high rates of progression to active disease observed in some populations of latently infected individuals. A range of factors that disproportionately affect migrants and ethnic minorities, including genetic susceptibility, vitamin D deficiency and co-morbidities such as diabetes mellitus and HIV, also increase vulnerability to infection with Mycobacterium tuberculosis (M.tb) or reactivation of latent infection. Furthermore, ethnic socio-economic disparities and the experience of migration itself may contribute to differences in TB incidence, as well as cultural and structural barriers to accessing healthcare. In this review, we discuss both biological and anthropological influences relating to risk of pathogen exposure, vulnerability to infection or development of active disease, and access to treatment for migrant and ethnic minorities in the UK.
Highlights
Tuberculosis (TB) is a bacterial disease caused by Mycobacterium tuberculosis (M.tb), which most commonly affects the lungs[1]
Social and cultural factors relating to risk of pathogen exposure, vulnerability to infection or development of active disease, and access to treatment which contribute to the increased incidence of TB in migrant and ethnic minorities in the UK (Figure 1)
A Canadian study found no evidence to support concerns about transmission from immigrants born in high-incidence countries. These findings suggest that reactivation of LTBI is more important in explaining the higher incidence of TB among migrants than exogenous infection due to local transmission
Summary
Any reports and responses or comments on the article can be found at the end of the article. Keywords Tuberculosis, UK, Migrants, Ethnic minorities, Socio-economic inequality, Stigma. The Introduction has been extended so as to emphasise the importance of both biological and social factors in explaining the disparity of TB incidence between migrants and ethnic minorities in the UK compared with the general population. 3 to 14 times higher than the white ethnic group[14]. There is much heterogeneity in both absolute number of cases and incidence rates (per 100,000 of population group) among migrants from different countries and among different ethnic groups. While number of cases is confounded by size of population group, variation in incidence rate reflects varying levels of risk for different migrant and ethnic groups. Migrants from the ISC (India, Pakistan and Bangladesh) and black ethnic groups demonstrate high incidence[15]
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