Risk of tuberculosis in immigrant Asians: culturally acquired immunodeficiency?

Area of Science:

• Epidemiology
• Infectious Diseases
• Public Health

Background:

• Asian immigrants in London present unique public health challenges.
• Tuberculosis (TB) incidence varies significantly among different Asian subgroups and compared to the general population.

Purpose of the Study:

• To investigate the patterns and risk factors of tuberculosis notifications among Asian immigrants in South London.
• To compare TB incidence between different Asian subgroups and with the white population.

Main Methods:

• Retrospective study of 620 Asian immigrants with tuberculosis notified between 1973 and 1988.
• Analysis of notification patterns, lag time between presentation and immigration, and risk factors using logit analysis.

Main Results:

• A bimodal notification pattern was observed, with peaks in 1977 (East African Asians) and 1981 (Indian subcontinent Asians).
• Mean lag time from clinical presentation to immigration was five years.
• Asian immigrants had a substantially higher TB incidence than white people, especially at extrapulmonary sites.
• Hindus, particularly women, had a significantly greater risk of TB than Muslims.
• Glandular TB was more common in women, and pulmonary TB in Hindu women compared to Hindu men.

Conclusions:

• Tuberculosis incidence among Asian immigrants in London is elevated, with specific patterns related to origin and religion.
• Dietary factors, such as vegetarianism and associated vitamin deficiencies in Hindus, may contribute to increased TB susceptibility, particularly in women.