Social factors associated with increases in tuberculosis notifications

Area of Science:

• Public Health
• Epidemiology
• Sociology

Background:

• Tuberculosis (TB) notifications in Liverpool have shown changes over the past 20 years.
• Assessing the roles of immigration and socioeconomic deprivation in these TB trends is crucial for public health strategies.

Purpose of the Study:

• To evaluate the independent contributions of immigration and deprivation to shifts in tuberculosis notifications in Liverpool.
• To analyze the relationship between socioeconomic factors, ethnicity, and TB rates across Liverpool's council wards.

Main Methods:

• Retrospective assignment of ethnic origin to TB cases from 1974 to 1995.
• Calculation of average TB rates for 33 Liverpool council wards during 1981-1985 and 1991-1995.
• Multiple regression analysis using census data (1981, 1991) to assess socioeconomic and population measures' effects on ward-based TB rates.

Main Results:

• The percentage of non-Caucasian TB cases steadily increased from 8.7% (1975-1977) to 28.0% (1993-1995).
• In 1981, only unemployment significantly correlated with TB rates. By 1991, two deprivation indices and ethnicity independently influenced TB rates.
• The rise in non-Caucasian TB cases occurred during both declining and increasing notification periods, questioning a direct immigration link to the overall increase.

Conclusions:

• While immigration may not solely explain the recent increase in TB notifications, its influence on disease distribution is evident.
• Ethnicity emerged as an independent factor in explaining TB rate variations between wards by 1991, unlike in the early 1980s.
• Socioeconomic deprivation and ethnicity are increasingly important factors in understanding tuberculosis epidemiology within urban populations.