12.1 Introduction

Tuberculosis (commonly called TB) is a disease caused by bacteria called Mycobacterium tuberculosis. TB usually affects the lungs, but can affect other parts of the body, such as the lymph nodes, the bones and coverings of the brain (meninges).  Globally, an estimated 9 million new persons develop TB each year¹.

12.2 National Picture

The numbers of new TB diagnosis in the UK has seen a steady increase from the year 2000 (6,726 cases) until the year 2005 (8,478). It has stabilised at this level since. The incidence rate also has shown a similar trend increasing from 11.4 per 100,000 population in 2000 to 14.1 in 2005. More recently it was 13.8 in 2007².

12.3 Regional Picture

The number of TB cases as well as the rate of TB in the West Midlands has shown a steady increase over the last 6 years. The incidence rate of TB has increased from 14.3 in 2003 to 18.4 in 2008 (Figure 12.1).

Figure 12.1: Tuberculosis cases and rates in the West Midlands (2003-2008)

Tuberculosis cases and rates in the West Midlands (2003-2008)

More cases occurred among men than women and the overall rate of infection was higher in men than women. The rate of TB in men increased from 15.7 per 100,000 population in 2003 to 19.1 in 2008. The rate for women also increased from 12.9 in 2003 to 17.7 in 2008 (Figure 12.2).

Figure 12.2: Tuberculosis cases and rates in the West Midlands by Gender (2003-2008)

Tuberculosis cases and rates in the West Midlands by Gender (2003-2008)

Majority of the cases occurred in the 15-44 year age group followed by the 45-64 year age group. The incidence rate has also shown an increase in the 15-44 year age group from 19.2 in 2003 to 27.0 in 2008. This is followed by the over 65-age band which has shown a steady rate from 2003 till 2007 and then slightly increased in 2008 (Figure 12.3).

Figure 12.3: Tuberculosis cases and rates in the West Midlands by age group (2003-2008)

Tuberculosis cases and rates in the West Midlands by age group (2003-2008)

More than half of the total cases (56%) reported in the six-year period between 2003 and 2008 were diagnosed as Pulmonary TB and 44% as extra-Pulmonary.  The proportion of extra-pulmonary TB cases increased in 2005 compared with 2003 and 2004 and since has remained at the same level (Figure 12.4).

Figure 12.4: Site of Tuberculosis disease in the West Midlands 2003-2008

Site of Tuberculosis disease in the West Midlands 2003-2008

Nearly one half of the cases occurred among Indian and Pakistani ethnic groups (26% and 23% respectively), followed by the White ethnic group (21%). (Figure 12.5)

Figure 12.5: Tuberculosis cases in West Midlands by Ethnicity 2003-2008

Tuberculosis cases in West Midlands by Ethnicity 2003-2008

There were widespread variations in TB rates between PCTs with Heart of Birmingham PCT having the highest rates, followed by Sandwell, Wolverhampton and Birmingham East & North PCTs. The rate of TB has been steadily increasing in Coventry PCT from 2003 to 2008 (Figure 12.6).

Figure 12.6: Tuberculosis rates in West Midlands Primary Care Trusts (2003-2008)

Tuberculosis rates in West Midlands Primary Care Trusts (2003-2008)

12.4 Tuberculosis and Deprivation

Deprivation was found to be a key determinant amongst the TB cases. Majority (65%) of the total cases reported during the six-year period of 2003 to 2008 were amongst people who lived in the most deprived quintile of IMD rank (Figures 12.7and 12.8).

Figure 12.7: Proportion of Tuberculosis cases by Quintile of Deprivation in the West Midlands 2003-2008

Proportion of Tuberculosis cases by Quintile of Deprivation in the West Midlands 2003-2008

Map 12.1: Tuberculosis cases in West Midlands by Lower Super Output Areas 2003-2008

Tuberculosis cases in West Midlands by Lower Super Output Areas 2003-2008

As the deprivation decreased the proportion of TB cases also decreased and this was statistically significant for each quintile compared with its previous quintile (Table 12.1).

Table 12.1: Proportion of tuberculosis cases (with 95%CI) in the West Midlands by quintile of deprivation (IMD 2007 Rank*)

* Methodology: All case records on the Enhanced TB surveillance database were extracted for the years 2003 till 2008. Records which had incomplete postcodes were excluded. Postcodes from the remaining records were matched against their Lower Super Output Areas (LSOAs) and their corresponding IMD ranks. A total of 5,349 records were found to be complete and were included in the analysis

12.5 Summary

The rate of TB has increased in the West Midlands between 2003-2008. TB is affecting predominately men of South Asian origin who are in the age group of 15-44. Majority (65%) of cases diagnosed in the West Midlands were amongst people who lived in the most deprived quintile of IMD rank.

References:

1. World Health Organisation. WHO REPORT 2009: Global Tuberculosis Control EPIDEMIOLOGY, STRATEGY, FINANCING. Available at http://www.who.int/tb/publications/global_report/2009/pdf/full_report.pdf (accessed June 2009)


2. Tuberculosis in the UK: Annual report on tuberculosis surveillance in the UK 2008. London: Health Protection Agency Centre for Infections, October 2008