Bhatti N, Law M R, Morris J K, Halliday R, Moore-Gillon J
Department of Public Health, East London and City District Health Authority.
BMJ. 1995 Apr 15;310(6985):967-9. doi: 10.1136/bmj.310.6985.967.
To examine factors responsible for the recent increase in tuberculosis in England and Wales.
Study of the incidence of tuberculosis (a) in the 403 local authority districts in England and Wales, ranked according to Jarman score, and (b) in one deprived inner city district, according to ethnic origin and other factors.
(a) England and Wales 1980-92, and (b) the London borough of Hackney 1986-93.
Age and sex adjusted rate of tuberculosis.
In England and Wales notifications of tuberculosis increased by 12% between 1988 and 1992. The increase was 35% in the poorest 10th of the population and 13% in the next two; and in the remaining 70% there was no increase. In Hackney the increase affected traditionally high risk and low risk ethnic groups to a similar extent. In the "low risk" white and West Indian communities the incidence increased by 58% from 1986-8 (78 cases) to 1991-3 (123), whereas in residents of Indian subcontinent origin the increase was 41% (from 51 cases to 72). Tuberculosis in recently arrived immigrants--refugees (11% of the Hackney population) and Africans (6%)--accounted for less than half of the overall increase, and the proportion of such residents was much higher than in most socioeconomically deprived districts. The local increase was not due to an increase in the proportion of cases notified, to HIV infection, nor to an increase in homeless people.
The national rise in tuberculosis affects only the poorest areas. Within one such area all residents (white and established ethnic minorities) were affected to a similar extent. The evidence indicates a major role for socioeconomic factors in the increase in tuberculosis and only a minor role for recent immigration from endemic areas.
研究英格兰和威尔士近期结核病发病率上升的相关因素。
对结核病发病率进行研究，（a）在英格兰和威尔士的403个地方政府辖区，按贾曼评分进行排名；（b）在一个贫困的市中心城区，按种族及其他因素进行研究。
（a）1980 - 1992年的英格兰和威尔士，以及（b）1986 - 1993年的伦敦哈克尼行政区。
年龄和性别校正后的结核病发病率。
在英格兰和威尔士，1988年至1992年间结核病通报病例增加了12%。最贫困的十分之一人口中增加了35%，接下来的两个十分之一人口中增加了13%；而其余70%的人口中没有增加。在哈克尼，发病率上升对传统上高风险和低风险种族群体的影响程度相似。在“低风险”的白人和西印度裔社区，发病率从1986 - 1988年的78例增加到1991 - 1993年的123例，增幅为58%，而印度次大陆裔居民的发病率增加了41%（从51例增至72例）。近期抵达的移民——难民（占哈克尼人口的11%）和非洲人（占6%）——导致的结核病病例增加不到总体增幅的一半，且这些居民的比例远高于大多数社会经济贫困地区。当地发病率的上升并非由于通报病例比例增加、HIV感染或无家可归者数量增加。
全国结核病发病率上升仅影响最贫困地区。在其中一个这样的地区，所有居民（白人和已定居的少数族裔）受到的影响程度相似。证据表明社会经济因素在结核病发病率上升中起主要作用，而来自结核病流行地区的近期移民仅起次要作用。
