Whither Tuberculosis?: A Statistical Review of Reports from Selected American and European Communities

Abstract

Tuberculosis mortality has been declining at an accelerated rate, especially during the past few years. Between 1945 and 1950, the death rate fell in England and Wales by 36 per cent; in the United States, 41 per cent; in Canada, 43 per cent; in France, 49 per cent; in Finland, 50 per cent; Italy, 53 per cent; Norway, 55 per cent; Denmark, 58 per cent; Sweden, 63 per cent; Iceland, 71 per cent; and in the Netherlands, 78 per cent. Tuberculosis morbidity, on the other hand, has tended to remain on a high level: 100,772 new cases reported in the United States in 1940 and 121,228 in 1950; in Canada, 10,226 formerly and 12,429 lately; in England and Wales, 49,967 notifications ten years ago and 52,062 last year; in Denmark, 2,687 new pulmonary cases in 1940 and 2,507 in 1950. Effective prevention of tuberculosis obviously remains elusive so far. Improved forms of treatment in tuberculosis are responsible for the lowering of “community case fatality rates” which ranged between 50 and 60 per cent in 1940, but were reduced in 1950 to 31 per cent in England and Wales, 29 per cent in Scotland and in Canada, 28 per cent in the United States, and only 20 per cent in Denmark. Children have generally enjoyed greater reductions of tuberculosis mortality than older groups of the population. Their death rate in the United States, in spite of an increasing concentration of population in urban, congested centers and large Negro groups has been steadily reduced. Among those under 15 years of age, in the year 1949 it averaged for the entire country 3.9 per 100,000. In the state of Minnesota, it was as low as 1.3. Abroad, the same year, the death rate of the children in Denmark was 3.6; but, in Norway, it was 8.1; and in England and Wales 12.1. BCG vaccination has been widely used in the Scandinavian countries—little in Iceland—and only very recently to any extent in the United States or in England and Wales. In the state of New Jersey, special measures for the protection of school children—periodic x-ray examination of school personnel along with tuberculin testing and x-raying of pupils annually—resulted in 1949 in reducing the death rate of children under 15 to 2.7 or only one-third of that prevailing in Norway. The death rate of the children in Denmark was 44 per cent of that of Norway. Appreciative acknowledgments are due particularly to the following European authorities who promptly made available their latest tuberculosis data: Miss Julie E. Backer, Chief of the Demographic Section of the Norwegian Central Bureau of Statistics; Dr. Konrad Birkhaug, former Director, National B.C.G. Laboratory, Bergen, Norway; Dr. Tobias Gedde-Dahl, Secretary-General, Norwegian National Tuberculosis and Public Health Association; A. Koller, Director, Swiss Federal Bureau of Statistics; Prof. Giovanni L'Eltore, General Secretary, Italian Federation Against Tuberculosis; Valter Lindberg, Central Statistical Office, Finland; Miss Marie Lindhardt, Head, Statistical Section, The National Health Service of Denmark; Dr. John Lundquist, Secretary-General, Swedish National Association against Tuberculosis; Dr. Sigurdur Sigurdsson, Medical Director, Tuberculosis Control, Iceland; Dr. Norman Smith, Deputy Senior Medical Officer, Ministry of Health, England; Dr. J. Ch. W. Verstege, Deputy Director General, Netherlands Central Bureau of Statistics.