The epidemiology of tuberculosis by ethnic group in Birmingham and its implications for future Trends in tuberculosis in the UK

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Abstract
To describe the epidemiology of tuberculosis (TB) in Birmingham, UK, by ethnic group and to assess the implications of the findings for future trends in TB in the UK. Retrospective review of records of all patients notified with TB in Birmingham during 1989-1994. The decline in TB notifications in Birmingham halted and then reversed in 1987-1992. Trends in overall notifications were mainly influenced by trends in cases of Asian origin. Crude notification rates in 1989-1994 are 17 times higher in Asian than Caucasian residents (p < 0.01). Rates in African Caribbean residents are also statistically significantly higher than in Caucasians (p < 0.01) but significantly lower than in Asians. Crude rates for Asian people born abroad are 4.1 times higher than for Asians born in the UK (p < 0.01) but only 3.8% of Asian patients had been resident in the UK for less than 1 year. The group accounting for the highest number of cases were female Asians aged 20-29, followed by male Asians of the same age. Age-specific rates show that incidence increases with age in both Asian and white groups, with a small peak in 20-29-year-old Asians. TB is uncommon in all Caucasian age-groups under 50 years of age (less than 1 per 10,000) but is relatively common in all Asian age-groups over 15 years of age (over 10 per 10,000). The different epidemiology of TB in the Caucasian and Asian populations in the UK suggests that from about the second decade of the next century, TB in the UK will almost be entirely a problem of ethnic minorities and that even if new infection was eliminated now in Asian people, cases due to reactivation would continue to occur until the third quarter of the next century.