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 withMycobacterium 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)
It is a common misconception that migrants have a higher incidence of TB disease compared with the general population because they ‘import’ it from abroad
Summary
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). The countries of origin with the highest number of homeless TB cases were Somalia, at 84 cases, and Eritrea, at 71 cases[9] This suggests that socio-economic disadvantage may play a important role in explaining higher TB incidence among the black-African and black-Caribbean ethnic groups. Migrants are at a higher risk of contracting TB due to the various unique factors discussed (including genetics, vitamin D deficiency, co-morbidities, and experiences of migration), which do not apply to the UK-born, making socioeconomic issues the key driver of TB incidence in this group. In 2016, nearly three times as many UK-born cases (22%) as foreign-born cases (8%) had at least one social risk factor (drug misuse, alcohol misuse, homelessness, or imprisonment)[9], which is incongruent with the higher overall rates of deprivation in foreign-born compared with UK-born populations[23]
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