Tuberculosis, deprivation, and ethnicity in Leeds, UK, 1982-1997

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Abstract
AIMS To determine whether tuberculosis is increasing in frequency and to explore the association between deprivation, ethnicity, and tuberculosis in the city of Leeds. METHODS Descriptive epidemiology and ecological analysis of a register of children and young people (0–18 years) diagnosed with tuberculosis from 1982 to 1997 in Leeds Health Authority. RESULTS A total of 107 children were identified, 61 through contact tracing, to give an age and sex standardised incidence rate of 3.9 per 100 000 per year. Rates decreased over the 16 year study period by an estimated 6.6% per year. The disease was more common in girls (56%) and most frequent in 5–9 year olds, with respiratory disease accounting for the largest proportion (82%). Children of south Asian origin (35%) had a crude incidence rate of 25.7 per 100 000 per year. The female:male ratios differed notably between south Asian (1.9:1) and non-south Asian children (1.02:1). For all subjects, univariate analyses showed significant positive associations between incidence and deprivation, population density, and ethnicity. There were no significant associations between deprivation, population density, and ethnicity and incidence of tuberculosis in south Asian children. For non-south Asian, mainly white children, only deprivation was significant. The proportion of non-south Asian children in the population was the overriding factor influencing incidence of tuberculosis. CONCLUSIONS Tuberculosis remains an uncommon disease in Leeds children. An unexpected finding was a relatively higher incidence in Asian girls compared to boys. Overall, ethnicity explains a high proportion of disease independently of deprivation and population density but for non-south Asian Leeds children the strongest risk factor is deprivation.