TB incidence and epidemiology, England, 2022
Updated 15 February 2024
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Main messages
In 2022:
- England remained a low tuberculosis (TB) incidence country with a TB notification rate of 7.75 per 100,000 population, below the World Health Organization (WHO) threshold (10 per 100,000 population)
- England was not on target to reach the commitment to reduce TB incidence by 90% from 2015 to 2035 and TB rates in 2022 diverged further from the trajectory required to reach elimination
- TB rates remained highest in large urban areas, particularly in some local authority areas in London, Leicester, and Slough
- almost 80% of active TB notified in England was in people born outside the UK in whom rates remained high and steady, while rates of new TB notifications continued to slowly fall in those born in the UK
- the most common countries of birth for those born outside of the UK were India, Pakistan, Romania, Bangladesh and Eritrea
- TB in England continued to disproportionately affect the most deprived populations, including groups at risk of exclusion and other health inequalities; infectious pulmonary disease was also more common in these groups
- social risk factors (SRF) in people notified with TB were more commonly identified in the UK born, with 21.6 % having at least one SRF compared with 15.3% in the non-UK born
- drug misuse was the most common SRF in those born in the UK (15.3%) compared with homelessness (6.5%) and being an asylum seeker (6.4%) in the non-UK born population
International context
TB remains the second leading single agent infectious killer after COVID-19, with more than 10 million people falling ill with TB every year and 1.4 million dying globally.
WHO established a global End TB Strategy in 2015. This aims to end the global TB epidemic as part of the United Nations (UN) sustainable development goals. The strategy places communities and people affected by TB at the heart of TB control. It aims to eliminate the global TB epidemic by achieving the following targets by 2035 (compared with 2015 baseline):
- reduce TB deaths by 95%
- reduce new TB notifications by 90%
- ensure that no family is burdened with catastrophic costs
The full political declaration can be found on the WHO website.
The current global trajectory of TB decline makes these ambitious targets.
For England this means by 2035:
- a reduction in TB deaths from 298 to 15 (in those treated for non-multidrug-resistant or rifampicin-resistant TB)
- a reduction in TB notification rate from 10.5 to 1.05 per 100,000 population, very close to the pre-elimination target of 1.0 per 100,000 population
The World Health Organization reported substantial disruption to global TB services during the COVID-19 pandemic with large reductions in the numbers of people being diagnosed and treated. Between 2019 and 2020 the number of people newly diagnosed with TB fell from 7.1 million to 5.8 million, with a partial recovery to 6.4 million in 2021. The most immediate impact of a reduction in case detection was on TB mortality which rose for the first time in 15 years to 1.4 million in 2020.
In 2022, WHO reported substantial recovery in global case detection with 7.5 million newly diagnosed, higher than pre-COVID numbers and the highest number of new cases for a single year since WHO monitoring began. Similarly, the most immediate impact of the global recovery in case detection was on TB mortality which fell in 2022 to 1.3 million.
It takes longer for the increased transmission and development of TB during the COVID-19 pandemic to be reflected in an increase in the global incidence rate. This is due to the time lag from infection to progression to TB disease, which ranges among individuals from months to years. Between 2020 and 2022 WHO reported an increase of 3.9% in the global incidence rate of TB, reversing 2 decades of continuous decline and further diverting global TB elimination targets. It will take longer for the recent recovery in global case detection to be reflected in the global TB incidence rate. (WHO global tuberculosis report 2023).
National epidemiology and progress towards the WHO elimination targets
TB in England
TB has been a notifiable disease in England and Wales since 1913, when 117,000 people were notified (corresponding to an incidence rate of 300 per 100,000). TB notifications subsequently declined, reaching a low in England in 1987 (4,854 people notified), corresponding to a TB notification rate of 10.3 per 100,000 (Figure 1). Between 1987 and 2011, a 70% increase in notifications was seen. This was followed by a 47.1% reduction between 2011 and 2022, (8,281 in 2011 compared with 4,380 in 2022) but the rate of reduction has slowed in the last 4 years, reaching a plateau in 2021 to 2022 of around 7.8 per 100 000 (Figure 1).
Figure 1. Number of TB notifications and TB notification rate per 100,000, England, 1971 to 2022
The data used in this graph can be found in Supplementary Table 1 of the accompanying data set.
Figure 2 shows that to meet the WHO target, TB notification rates needed to fall from 2015 at 10.9% annually, much greater than observed. To meet this target a year-on-year decrease from 2023 of 12.5% is required. The only year, outside of the peak COVID-19 pandemic year of 2020, that a decrease of this magnitude has occurred was 1987. Between 2017 and 2022 the average decrease per year was 2.7% with almost no change from 2021 to 2022. Based on this rate of change England would reach a rate of 5.5 per 100,000 population in 2035 – far short of the target of 1.05 per 100 000.
Figure 2. Observed rates of decrease in TB notification in England from 2010 to 2035 compared with required rate of decrease to achieve the WHO End TB goal of a 90% reduction in TB incidence from 2015 to 2035
The data used in this graph can be found in Supplementary Table 2 of the accompanying data set.
TB notification rates compared with the rates required for the WHO goal are shown in Figure 3 below. This figure also includes the estimated rate of TB for 2023, based on a projection of the likely final number of TB notifications in 2023. This projection suggests a total number of TB notifications of 4,853, the largest increase in numbers since 2005.
Figure 3. Required rates and excess observed TB rates to meet 90% reduction by 2035, England, 2017 to 2022 with projection for 2023
The data used in this graph can be found in Supplementary Table 3 of the accompanying data set.
TB notification numbers, notification rates and geographical distribution
In 2022 England remained a low TB incidence country with a rate of 7.75 per 100,000 (95% CI 7.52 to 7.98 per 100,000), below the WHO threshold of 10 per 100,000, but not on track for the WHO elimination target of 2035. There were 4,380 individuals notified with TB in England in 2022), very similar to 2021 (4,411 notifications and a rate of 7.80 per 100,000; 95% CI 7.57 to 8.04 per 100,000).
Geographical variation in the number and notification rate of people with TB
TB numbers and rates by NHS England and UK Health Security Agency (UKHSA) regions in 2022
In 2022 the NHS region with the highest TB notification rate was London at 17.9 per 100,000 population, approximately 6 times higher than the rate in the South West with a rate of 2.8 per 100,000 population (Table 1). There were no significant changes in rates between 2021 and 2022 for the 7 NHS regions.
Table 1. Number of TB notifications and annual notification rates per 100,000 people by NHS region, England, 2022
| NHS region | Number of TB notifications | TB notification rate (95% CI) |
|---|---|---|
| London | 1,575 | 17.9 (17.0 to 18.8) |
| Midlands | 922 | 8.5 (8.0 to 9.1) |
| North West | 494 | 6.7 (6.1 to 7.3) |
| South East | 478 | 5.3 (4.8 to 5.8) |
| North East and Yorkshire | 381 | 4.7 (4.2 to 5.2) |
| East of England | 369 | 5.6 (5.0 to 6.2) |
| South West | 161 | 2.8 (2.4 to 3.3) |
Appendix Figures A1a to A1c show notifications in each of the 9 UKHSA regions over time from 2012 to 2022.
TB notifications and rates by NHS region and by UKHSA region for notifications from 2000 to 2022 are shown in Supplementary Tables 4 and 5 of the accompanying data set.
TB numbers and notification rates for integrated care boards, clinical commissioning groups and local authorities (3-year average rates 2019 to 2022)
Integrated care boards (ICBs) replaced clinical commissioning groups (CCGs) in 2022. TB notifications and rates aggregated for notifications between 2020 and 2022 are presented for both ICBs and CCGs in Supplementary Tables 6 and 7 of the accompanying data set.
In 2022, no ICBs had achieved the WHO global pre-elimination rate of less than 1.0 per 100,000 and nearly a quarter (23.8%, 10 out of 42) had rates above 10 per 100,000. The main burden of disease remained concentrated in large urban areas, which is demonstrated best by 3-year average notification rates (2020 to 2022) by local authority areas (Figure 4a, 4b and Supplementary Table 8).
In 2022, only one local authority district had a 3-year average notification rate above 40 per 100,000. This was Newham (41.3 per 100,000). A further 5 local authority areas had rates between 30 and 40 per 100,000. These were Leicester (38.9), Brent (37.4), Harrow (31.8), Ealing (30.5) and Slough (30.2).
Overall, 4.5% (14 local authorities) had a pre-elimination rate of less than 1.0 per 100,000.
Figure 4a. Three-year average TB notification rates by local authority district in London, England, 2020 to 2022
Note: due to small numbers, small local authorities were merged to neighbouring local authorities. City of London is merged to Hackney, and merged rates are presented in this figure.
The data used in this graph can be found in Supplementary Table 8 of the accompanying data set.
Figure 4b. Three-year average TB notification rates by local authority district, England, 2020 to 2022
Contains Ordnance Survey data © Crown copyright and database right 2022.
Contains National Statistics data © Crown copyright and database right 2022.
Note: UKHSA region boundaries are outlined in black.
The data used in this graph can be found in Supplementary Table 8 of the accompanying data set.
Social and demographic characteristics of people with TB in England
Notification rates of TB by sex, age, place of birth (UK versus non-UK born) and time since entry to the UK
TB notifications and rates in the non-UK born and UK born populations
The incidence of active tuberculosis continued to fall in the UK born population (a 9.5% decrease in 2022 compared to 2021), but in the non-UK born population incidence rates remained steady and high. Non-UK born individuals accounted for 79.1% of new TB diagnoses in 2022, compared with 71.5% in 2017 (Table 2).
Table 2. Proportion of TB notifications in the non-UK born and TB notification rates by place of birth, England, 2017 to 2022
| Year | Non-UK born (%) | Non-UK born rate (95% CI) | UK born rate (95% CI) |
|---|---|---|---|
| 2017 | 71.5 | 41.3 (40.0 to 42.7) | 3.1 (2.9 to 3.2) |
| 2018 | 72.0 | 39.0 (37.7 to 40.4) | 2.7 (2.6 to 2.9) |
| 2019 | 73.7 | 39.7 (38.4 to 41.1) | 2.6 (2.5 to 2.8) |
| 2020 | 73.2 | 36.8 (35.5 to 38.1) | 2.3 (2.2 to 2.4) |
| 2021 | 77.1 | 37.5 (36.3 to 38.8) | 2.1 (2.0 to 2.3) |
| 2022 | 79.1 | 37.5 (36.2 to 38.8) | 1.9 (1.8 to 2.1) |
Further data about TB notifications and rates in the UK born and non-UK born is available in supplementary data sets and shown in figures in the Appendix:
- numbers and proportions by age and sex in 2022 – Supplementary Table 9, Appendix Figure A2
- numbers and rates by 5-year age groups and sex in 2022 – Supplementary Table 10, Appendix Figure A3
- England 2000 to 2022 – Supplementary Table 11
- by UKHSA region 2000 to 2022 – Supplementary Table 12
Countries of birth and time between entry to the UK and TB notification
In 2022, 46.3% (1,412 out of 3,048) of people with TB born outside the UK with known year of entry were notified less than 6 years since entering the UK with 23.3% (711 out of 3,048) being notified within 2 years. These proportions are the highest since 2012 (Figure 5 and Supplementary Table 13 of the accompanying data set).
Figure 5. Time between entry to the UK and TB notification for people born outside the UK, England 2011 to 2022
The data used in this figure can be found in Supplementary Table 13 of the accompanying data set.
Table 3 shows country of birth for all people notified with TB in 2022 and median time between year of entry to the UK and TB notification. For those born outside of the UK the most common country of birth was India, which has been the case since 2000 (supplementary Table 14 of the accompanying data set). For the first time, there were more TB notifications in people born in India than in those born in the UK in 2022. TB notifications for the 5 most frequent countries of birth (Pakistan, Romania and so on) between 2011 and 2022 are also shown in Appendix Figure A4. The median time between TB notification and year of entry to the UK also varied by country of birth, with notably shorter durations for Afghanistan, Sudan and Eritrea.
Table 3. Countries of birth and time between entry to the UK and TB notification, England, 2022
| Country of birth | Number of people notified with TB | Proportion of people notified with TB (%) | Median time since entry to UK (IQR) in years |
|---|---|---|---|
| India | 969 | 22.2 | 5.0 (1.0 to 15.0) |
| United Kingdom | 915 | 21.0 | N/A |
| Other | 737 | 16.9 | 9.0 (3.0 to 20.0) |
| Pakistan | 485 | 11.1 | 11.0 (2.0 to 24.0) |
| Romania | 207 | 4.7 | 5.0 (3.0 to 7.0) |
| Bangladesh | 123 | 2.8 | 9.5 (2.0 to 21.0) |
| Eritrea | 119 | 2.7 | 2.0 (0.0 to 5.0) |
| Nigeria | 118 | 2.7 | 2.5 (0.0 to 16.0) |
| Somalia | 93 | 2.1 | 9.0 (1.0 to 19.0) |
| Philippines | 92 | 2.1 | 11.5 (3.0 to 18.0) |
| Afghanistan | 91 | 2.1 | 1.0 (0.0 to 10.5) |
| Poland | 82 | 1.9 | 10.0 (6.0 to 16.0) |
| Nepal | 76 | 1.7 | 4.0 (2.0 to 13.0) |
| Sudan | 66 | 1.5 | 1.0 (0.0 to 5.0) |
| Sri Lanka | 53 | 1.2 | 19.0 (10.0 to 29.0) |
| Ethiopia | 49 | 1.1 | 6.0 (1.5 to 15.5) |
| Kenya | 47 | 1.1 | 21.0 (1.0 to 45.0) |
| Total | 4,366 | 100 | Add total median time |
Notes
1. Place of birth (UK non-UK) and or country of birth is missing for 14 notifications in 2022
2. IQR stands for inter-quartile range.
3. Time between entry to the UK and TB notification is calculated as whole years (only year of entry is reported to National TB Surveillance (NTBS).
4. Time since entry to the UK was not known for 404 people.
Important characteristics of people notified in 2022 born outside of the UK from the 5 most frequent countries of birth are shown in Supplementary Table 15 of the accompanying data set and include mean age, proportion of males, pulmonary TB and proportion of recent entrants (TB notified within 2 years of entry to the UK) and pulmonary TB in recent entrants.
People born in Eritrea compared with the South Asian countries were notably younger and with a higher proportion of males (77.3%, compared with 55.5% to 57.4%) and the highest proportion of new entrants (39.4%), of whom 65.9% had pulmonary TB. People born in Romania were also younger than those born in South Asia and had a very high proportion of pulmonary TB (81.2%) compared with 36.6 to 44.5% in people born in South Asian countries.
Differences in TB notification rates between UK and non-UK born populations of the same ethnic group
Figure 6 and Supplementary Table 16 of the accompanying data set show the number of TB notifications and the TB notification rate for 9 different ethnic groupings in those born in the UK compared with those of the same ethnic grouping born outside the UK. In the UK born, the most common ethnic grouping was white but the notification rate in this group was the lowest (1.2 per 100,000) compared with highest in the Black – other grouping (19.7 per 100,000). TB notification rates were higher in the non-UK born compared with the UK born population of the same ethnic grouping. The highest rate in non-UK born individuals was in people in the Indian ethnic grouping (93.4 per 100,000). The highest difference between UK born and non-UK born observed for the Chinese (approximately 20 times greater), Indian and White ethnic groupings (approximately 10 times greater).
Figure 6. Number of TB notifications and rates in ethnic groups by place of birth (UK and non-UK born), England, 2022
The data used in this figure can be found in Supplementary Table 16 of the accompanying data set.
Changes over time in TB notifications and notification rates by ethnic groupings and place of birth
Number of notifications from 2000 to 2022 in 4 ethnic groupings are shown in Figure 7 and separated by place of birth (UK compared with non-UK born) in Appendix Figure A5a and A5b. The largest number of notifications across this whole period was in people from the South Asian (Indian, Pakistani, Bangladeshi) ethnic group. Numbers in this group reached a peak in 2011 and declined steadily until 2018 since when they have risen by 10.1% (1,619 individuals in 2022, 1,471 in 2018) (Supplementary Table 17 of the accompanying data set).
Figure 7. All notifications of number of people with TB in the UK by ethnic group, England, 2000 to 2022
The data used in this figure can be found in Supplementary Table 17 of the accompanying data set.
Clinical characteristics of disease
Site of disease
The site of disease influences clinical and public health management. Just over half of people with TB notified in 2022 had pulmonary disease, which may lead to onward transmission (54.7%, 2398 out of 4380) (Table 4). This proportion is consistent with previous years.
Table 4. TB case notifications by site of disease, England, 2022
| Type | Site of disease | Number of notifications | Percentage |
|---|---|---|---|
| Pulmonary | All pulmonary | 2,398 | 54.7 |
| Pulmonary | Miliary | 136 | 3.1 |
| Pulmonary | Laryngeal | 10 | 0.2 |
| Extra-pulmonary | All extra-pulmonary | 2,677 | 61.1 |
| Extra-pulmonary | Extra-thoracic lymph nodes | 917 | 20.9 |
| Extra-pulmonary | Intra-thoracic lymph nodes | 636 | 14.5 |
| Extra-pulmonary | Pleural | 309 | 7.1 |
| Extra-pulmonary | Other extra-pulmonary | 983 | 22.4 |
| Extra-pulmonary | Gastrointestinal | 225 | 5.1 |
| Extra-pulmonary | Bone – spine | 203 | 4.6 |
| Extra-pulmonary | Bone – not spine | 95 | 2.2 |
| Extra-pulmonary | Central nervous system (CNS) – meningitis | 115 | 2.6 |
| Extra-pulmonary | Genitourinary | 56 | 1.3 |
| Extra-pulmonary | Central nervous system (CNS) – other | 50 | 1.1 |
| Extra-pulmonary | Cryptic disseminated | 48 | 1.1 |
Note: Individuals may have more than one site of disease. Pulmonary disease includes those with or without disease at another site in addition to the lungs, so the total number for all sites is more than the number of people with TB disease in 2022.
Risk factors for pulmonary disease
Males, people born in the UK, children and older adults (over 65 years) and people with social risk factors are all more likely to have pulmonary TB at the time of diagnosis (Figure 8 and Supplementary Table 18 of the accompanying data set).
Figure 8. Risk factors for pulmonary TB disease, England, 2020 to 2022
Note: reference groups for RRs in the order presented in the above figure are: female, born outside of the UK, no SRFs, none or one SRF, no history of imprisonment and aged 15 to 44 years old.
The data used in this figure can be found in Supplementary Table 18 of the accompanying data set.
Co-morbidities in TB
Comorbidities with other infections or non-communicable diseases such as diabetes or chronic renal disease may affect TB susceptibility, treatment strategies and outcomes. In 2022, 21.2% (954 out of 4,380) of all people with TB were known to have at least one co-morbidity, unchanged from 2021.
People with type 2 diabetes have an increased risk of developing TB disease (‘Association between diabetes mellitus and active tuberculosis’) and may have worse treatment outcomes. Diabetes was the most frequently reported co-morbidity at 13% in 2022 (Table 5a) followed by immunosuppression (7.5%). The relative contribution of the causes of immunosuppression are in Table 5b.
Untreated HIV infection increases the risk of developing active TB disease and universal HIV testing is conducted within TB programmes. The proportion of people being offered HIV testing is recorded in NTBS although test results are not. In 2022 98.2% of individuals notified with unknown HIV status were offered an HIV test. Details of how HIV status is captured for analysis of HIV co-infection presented below can be seen in the Methodology and definitions chapter.
In 2022 HIV coinfection was recorded in 3.6% of individuals with TB, similar to 2021 and a decline since the peak of 8.5% in 2004. In 2022 the proportion of individuals co-infected with hepatitis B or C was 2.8% and those coinfected with HIV and hepatitis B or C was 0.3%. Hepatitis co-infection in TB has been stable since recording began in 2015. HIV and hepatitis co-infection over time is available in supplementary Table 19 of the accompanying data set.
Table 5a. Comorbidities in individuals with TB, England 2022
| Co-morbidity | Number of people with TB | Proportion (%) | Total with data recorded |
|---|---|---|---|
| Diabetes | 530 | 13.0 | 4,087 |
| Hepatitis B | 74 | 1.9 | 3,909 |
| Hepatitis C | 51 | 1.3 | 3,907 |
| Chronic liver disease | 58 | 1.4 | 4,031 |
| Chronic renal disease | 132 | 3.3 | 4,052 |
| Immunosuppression | 302 | 7.5 | 4,023 |
Table 5b. Causes of immunosuppression co-morbidity in people with TB, England, 2022
| Reason for immunosuppression | Number of people with TB | Proportion (%) | Total with data recorded |
|---|---|---|---|
| Biological therapy | 56 | 23.4 | 239 |
| Transplantation | 14 | 5.9 | 239 |
| Cancer | 70 | 28.9 | 242 |
| Steroids | 10 | 4.1 | 242 |
| Other or not known Immunosuppression | 162 | 66.9 | 242 |
Note: people may have more than one comorbidity recorded and more than one reason for immunosuppression. Reason for immunosuppression was missing for 63 individuals
Cigarette smoking
Smoking increases the risk of contracting TB and impairs the response to treatment. In 2022, 22.4% of people had a history of smoking (871 out of 3,895), and the prevalence of current smoking was 15.1% (590 out of 3,895). This compares with 17.5% in 2020 with a history of smoking – the lowest recorded in the previous 4 years with more complete data (less than 10% of missing smoking information).
Social risk factors, deprivation and risk of TB
Social risk factors
There are demographic, social and economic characteristics that can lead to people experiencing social exclusion, stigma and discrimination, resulting in barriers in access to healthcare, poor health outcomes and contributing to increasing health inequalities. These population groups are commonly referred to as inclusion health groups.
National TB Surveillance collects data on 6 specific social characteristics, referred to in this report as social risk factors (SRFs) that are commonly reported to increase the risk of TB and are associated with barriers in access to healthcare, and poor outcomes. These characteristics are: alcohol misuse, drug misuse, homelessness, imprisonment, mental health needs and asylum seeker status.
Unless otherwise stated, the following analyses exclude children under 15 years (136 notifications) leaving 4,244 notifications in the analysis for 2022. As a result of changes in collection of SRF data over time, analyses are restricted to 2018 onwards.
Full information about how the 6 social risk factors are recorded, and about definitions and data limitations, is available the Methodology and definitions chapter..
Proportions of people with TB and social risk factors
The proportion of people with TB with at least one SRF was 16.9% in 2022. This is similar to 2018 to 2021 when it was 14 to 15% each year (supplementary Table 20 in the accompanying data set).
Table 6 shows the proportions of people with each individual SRF for 2022 for all age groups, including children (for those with available data). The most common SRF in UK born individuals, excluding children, was drug misuse (15.3%; 116 out of 758 individuals) and for non-UK born people it was asylum seeker status (6.4%, 201 out of 3,149 individuals with recorded information). The increase in numbers with asylum seeker status in 2022 is likely in part due to increased ascertainment, as in previous years there were high levels of missing data for this SRF.
Table 6. Proportions of people with individual social risk factors (SRFs), England 2022 (all age groups, including children)
| Number of people with TB | Proportion (%) | Total with data reported | Number of missing data | Proportion of missing data (%) | |
|---|---|---|---|---|---|
| Drug misuse (current or previous) | 205 | 5.1 | 4,036 | 344 | 7.9 |
| Alcohol misuse (current) | 213 | 5.3 | 4,038 | 342 | 7.8 |
| Homelessness (current or previous) | 263 | 6.6 | 4,005 | 375 | 8.6 |
| Prison (current or previous) | 161 | 4.1 | 3,965 | 415 | 9.5 |
| Asylum seeker (current) | 210 | 5.2 | 4,049 | 331 | 7.6 |
| Mental health needs (current) | 144 | 3.6 | 3,974 | 406 | 9.3 |
| One or more SRF | 728 | 16.6 | 4,380 | 728 | 16.6 |
| More than one SRF | 308 | 7.5 | 4,122 | 258 | 5.9 |
Note: the denominator for more than one SRF is the number of people with data recorded for at least 2 out of the 6 SRFs.
Supplementary Table 20 of the accompanying data set shows the available data and proportions of SRFs over time between 2018 to 2022 for all people (excluding children aged less than 15) and by place of birth (UK-born and non-UK born).
Geographical distribution of social risk factors
Supplementary Table 21 of the accompanying data set shows the proportions of notifications with at least one SRF recorded by UKHSA region by year for 2018 to 2022.
Risk of social risk factors in people with TB
Social risk factors are more common in males and the UK born population
Figure 9 shows factors associated with having at least one SRF for people notified aggregated over the last 3 years (when more complete data is available). Males are 2 and a half times more likely than females to have one or more SRFs (risk ratio (RR) 2.52, 95% CI 2.09 to 3.04). Those recorded as unemployed are also 2 and a half times more likely (RR 2.52, 95% CI 2.15 to 2.95). Those born in the UK are nearly twice as likely (RR 1.93, 95% CI 1.66 to 2.24) to have a SRF compared with those born outside of the UK.
Figure 9. Relative risks of factors associated with having one or more SRFs in people notified with TB between 2020 to 2022 (aggregate data), England, 2022
Notes
1. Only those aged 15 years or older were included in the Figure.
2. Reference groups for RRs in the order presented in the above figure are: female, born outside of the UK, employed and aged 15 to 44 years old.
Data used in this figure can be seen in Supplementary Table 22 of the accompanying data set.
Analyses of risk factors for each SRF (aggregated over the last 3 years) are shown in Supplementary Table 22 of the accompanying data set. Males had a higher risk of each SRF compared with women. Older people had a lower prevalence of most SRFs apart from mental health needs. People born in the UK had a higher risk of all SRFs, especially drug misuse (RR 5.98, 95% CI 5.09 to 7.03) and prison (RR 4.42, 3.71 to 5.28). Unemployment was also associated with increased risk for each SRF. Drug misuse was the most common SRF in any of the subgroups at 15.9% in the UK born population, but increased to 24.9% when limited to male, UK-born and aged 15 to 44 years.
Prevalence of SRFs vary by ethnicity in the UK born population and country of birth in the non-UK born population
To further investigate what sub-populations have the greatest risk of SRFs, the proportions of SRFs by ethnicity (White, Black-Caribbean, Black-African, South Asian and Other), for those born in the UK and by country of birth for those born outside, are analysed (Supplementary Table 23 of the accompanying data set). Due to potentially small numbers in some of these sub-groups, data is presented for the years 2018 to 2021 combined.
In people with TB born in the UK, Black-Caribbean people had the highest proportion with at least one SRF (39.8%,103 people), with the most common being drug misuse (28.1%, 70 people) and imprisonment (18.3%, 45 people). Drug misuse, alcohol misuse and imprisonment were also the most common in UK born people with white ethnicity (15.0% 427 people; 11.0%, 132 people and 10.5%, 286 people)
In people born outside of the UK, the 10 most frequent countries of birth between 2018 to 2021 were analysed. People born in Eritrea and Sudan had the highest proportion of people with at least one SRF at 43.9% (260 people) and 48.4% (140 people). This resulted from the high proportion who were asylum seekers and/or homeless and reported imprisonment in immigration removal centres. Those born in European countries such as Poland and Lithuania had the largest proportions of people with alcohol misuse (20.6% 67 people and 25.9% 43 people), prison history (12.3% 37 people and 11.9% 19 people) as well as alcohol misuse (both over 10%).
TB notification rate increased with increased levels of deprivation
In 2022, the rate of TB was 13.5 per 100,000 in the 10% of the population living in the most deprived areas compared with only 2.6 per 100,000 in the 10% of the population living in the least deprived areas, with a clear trend of a decreasing rate of TB with decreasing deprivation (Figure 10).
Figure 10. TB notification rate by deprivation decile, England, 2022
Note: numbers above the bar in the figure are the point estimate of TB notification rate per 100,000 population.
Data used in this figure is available in Supplementary Table 24 of the accompanying data set.
Supplementary Table 25 of the accompanying data set shows characteristics of people with TB by deprivation decile in 2022. The proportion of UK born people and those with a social risk factor was generally higher in the most deprived areas.
Appendix
Figure A1a. Number of TB notifications (i) and rate (ii) by UKHSA region for London, 2012 to 2022
(i)
(ii)
Note: Y-axis scale differs from Figures A1b and A1c, due to higher notifications in London.
Figure A1b. Number (i) and rates (ii) of TB for West Midlands, South East, North West and East Midlands UKHSA regions 2012 to 2022
(i)
(ii)
Figure A1c. Number (i) and notification rates (ii) of TB for East of England, Yorkshire and Humber, South West and North East UKHSA regions, 2012 to 2022
(i)
(ii)
Data used in these graphs is available in Supplementary Table 3 in the accompanying data set.
Figure A2a. Age and sex distributions by place of birth for UK-born people, 2022
Figure A2b. Age and sex distributions by place of birth for non UK-born people, 2022
Data used in these graphs is available in Supplementary Table 8 in the accompanying data set.
Figure A3. Number of TB notifications (a) and rates (b) by age groups and by place of birth (UK and non-UK born), England, 2022
a)
b)
Data used in these graphs is available in Supplementary Table 9 in the accompanying data set.
Figure A4. Numbers of TB notifications for the top 5 countries of birth for the non-UK born population, England, 2011 to 2022
Data used in these graphs is available in Supplementary Table 13 in the accompanying data set.
Figure A5a. Number of UK born people with TB by ethnic group, England 2000 to 2022
Figure A5b. Number of non-UK born people with TB by ethnic group, England 2000 to 2022
Data used in these graphs is available in Supplementary Table 15 in the accompanying data set.