The geographical distribution of tuberculosis notifications in a national survey of England and Wales in 1983

Abstract

A survey of all tuberculosis notifications in England and Wales for the first 6 months of 1983 has made it possible to estimate the annual notification rates for that year for the White and the Indian subcontinent (Indian, Pakistani and Bangladeshi) ethnic groups for the nine regions of England and Wales and for the 33 boroughs of Greater London. The rates have been compared with those estimated from an earlier 6-month survey in 1978/79. However, for the 53 counties and the 370 local authority areas outside Greater London only the overall rates could be calculated because population data by ethnic group were not available. There was considerable variation between the 9 regions in the notification rates for all ethnic groups combined (range 28.1 per 100,000 in Greater London to 4.5 per 100,000 in Anglia) and for the White ethnic group (range 13.1 per 100,000 in Greater London to 3.1 per 100,000 in Anglia). The rates for the Indian subcontinent (ISC) ethnic group were high in all the regions and were 15-60 times higher than the corresponding rates for the White ethnic group. Between 1978/79 and 1983 there was a decline in all of the regions in the notification rates for all ethnic groups combined and the White group. For the ISC ethnic group there was a decline in all regions apart from Anglia (where the number of cases was small). The difference in rates for the London boroughs, from 92.3 per 100,000 for Brent to 5.7 per 100,000 for Havering, were associated not only with the proportion of the population who were of ISC ethnic origin but also with indices of socio-economic class for the borough. There was, however, no evidence to suggest that high rates in the White population were a consequence of the presence of a large number of infectious patients of ISC ethnic origin. Notification rates for the 53 counties apart from Greater London ranged from 23.7 per 100,000 for the West Midlands to 3.1 per 100,000 for Surrey and with few exceptions there was a decline in rates between the surveys. Considering the 370 local authorities outside Greater London, the number with a notification rate of less than 5 per 100,000 increased from 73 in 1978/79 to 105 in the 1983 survey and the number of local authorities in which no cases were notified in the 6-month survey period increased from 32 to 41.