Tuberculosis in England and WalesBMJ 1995; 311 doi: https://doi.org/10.1136/bmj.311.6998.187 (Published 15 July 1995) Cite this as: BMJ 1995;311:187
- Michael Catchpole, Senior medical statistician
Incidence of tuberculosis in London is rising against general recent trend
EDITOR,--The papers by N Bhatti and colleagues1 and Punam Mangtani and colleagues,2 are an important reminder of the relation between health and deprivation. Both papers highlight the increase in reported notifications of all forms of tuberculosis in England and Wales between 1986 and 1992. This increase continued into 1993, but the number of reported notifications of all forms of tuberculosis fell between 1993 and 1994.
I have looked at the notification data for England for 1993 and 1994. These show that the total number of notifications reported in 1994 was 4.6% lower than that in 1993 and 2.5% lower than that in 1992. The fall in the number of reported notifications of tuberculosis between 1993 and 1994 was not seen in all districts. If the districts are ranked according to the 1991 Department of Environment overall deprivation score those in the third with the highest deprivation scores reported 186 fewer cases in 1994 than in 1993 whereas those in the third with the lowest deprivation scores reported only two fewer cases in 1994 than in 1993.
A different picture emerges, however, if one looks only at notifications from London boroughs, which reported roughly 38% of all cases of notified tuberculosis in 1994. Despite the overall fall in reported notifications of tuberculosis from England between 1993 and 1994, there was a 6.8% increase in notifications from Greater London, with only 15 of the 33 London boroughs reporting fewer notified cases in 1994. If the London boroughs are ranked according to the 1991 Department of Environment overall deprivation score then those in the third with the highest deprivation scores reported 120 more cases in 1994 than in 1993 whereas those in the third with the lowest deprivation scores reported 25 fewer cases in 1994 than in 1993.
These data suggest that an encouraging fall in morbidity from tuberculosis occurred in England as a whole between 1993 and 1994 and that this fall was seen particularly in the more deprived areas of the country. Within London, however, the difference in morbidity from tuberculosis between the least and most deprived sections of the population increased between 1993 and 1994, with the rise in tuberculosis seen between 1986 and 1993 continuing in the most deprived areas of the capital while notification rates decreased in the least deprived areas.