Tuberculosis in the West Midlands, 1990-1991

In the late 1980s, notifications of tuberculosis stopped their former steady decline. There has been speculation as to why this should be so, with much interest centred on a possible association with the HIV epidemic. Notification rates are higher in persons of Indian subcontinent ethnic origin compared with the indigenous white population. Changes in the size and structure of the former population subgroup may have contributed to the recent increase in notifications in some areas. The absence of data on ethnic group in routinely collected data has led to the recommendation that special surveys should be conducted to clarify the contribution of ethnic minorities to the occurrence of tuberculosis in the UK. One such survey has been carried out in the West Midlands, where notifications increased by 27% between 1987 and 1989. Notification rates were found to vary widely by age, sex, district of residence and ethnic group; the highest notification rates occurring in older females of Indian subcontinent origin. These differences help to explain the increase in the absolute number of notifications and suggest that certain population subgroups warrant special attention.