Geographical distribution of tuberculosis notifications in national surveys of England and Wales in 1988 and 1993: report of the Public Health Laboratory Service/British Thoracic Society/Department of Health Collaborative Group

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Abstract
BACKGROUND The geographical distribution of tuberculosis in England and Wales and changes since 1983 were examined using data from the 1988 and 1993 national surveys of tuberculosis notifications. METHODS Notification rates for England and Wales in 1988 and 1993 were calculated for geographical areas using Office for National Statistics (ONS) mid year population estimates. Those for the standard regions and the Greater London boroughs were calculated for the main ethnic groups. Those for the counties and local authorities were calculated for all ethnic groups combined. These were compared using data from the 1983 national survey as a baseline. RESULTS Wide regional variations in notification rates persist with Greater London having the highest rates. Rates in the ethnic group from the Indian subcontinent (ISC) were high in all regions, whilst those of the white ethnic group varied fourfold. Twenty seven of the 33 London boroughs showed increased rates in 1993 compared with 1988. In general, those local authority areas with high rates had high proportions of notifications in individuals of ISC ethnic origin, emphasising the continuing important contribution of ethnic minority groups to local tuberculosis rates. The number of local authority areas with notification rates four times the national average increased, but the number of areas with low or zero rates increased even more. CONCLUSIONS The distribution of tuberculosis in England and Wales continues to vary markedly by geographical area. The distribution is becoming increasingly polarised with a growth in the number of areas with very high rates of notifications and a greater increase in the number of areas with very few notifications. Patients from ethnic minorities continued to contribute a substantial and increasing proportion of all reported tuberculosis cases in most regions in 1988 and 1993. These findings have important implications for the provision of tuberculosis services in England and Wales.