Geographical distribution of tuberculosis notifications in national surveys of England and Wales in 1988 and 1993: report of the Public Health Laboratory Service/British Thoracic Society/Department of Health Collaborative Group

摘要

BACKGROUND—The geographical distribution oftuberculosis in England and Wales and changes since 1983 were examinedusing data from the 1988 and 1993 national surveys of tuberculosis notifications.
METHODS—Notification rates for England and Walesin 1988 and 1993 were calculated for geographical areas using Officefor National Statistics (ONS) mid year population estimates. Those forthe standard regions and the Greater London boroughs were calculated for the main ethnic groups. Those for the counties and localauthorities were calculated for all ethnic groups combined. These werecompared using data from the 1983 national survey as a baseline.
RESULTS—Wide regional variations innotification rates persist with Greater London having the highestrates. Rates in the ethnic group from the Indian subcontinent (ISC)were high in all regions, whilst those of the white ethnic group variedfourfold. Twenty seven of the 33 London boroughs showed increased ratesin 1993 compared with 1988. In general, those local authority areaswith high rates had high proportions of notifications in individuals ofISC ethnic origin, emphasising the continuing important contribution ofethnic minority groups to local tuberculosis rates. The number of local authority areas with notification rates four times the national averageincreased, but the number of areas with low or zero rates increasedeven more.
CONCLUSIONS—The distribution of tuberculosis inEngland and Wales continues to vary markedly by geographical area. Thedistribution is becoming increasingly polarised with a growth in thenumber of areas with very high rates of notifications and a greaterincrease in the number of areas with very few notifications. Patientsfrom ethnic minorities continued to contribute a substantial andincreasing proportion of all reported tuberculosis cases in mostregions in 1988 and 1993. These findings have important implicationsfor the provision of tuberculosis services in England and Wales.