Research and analysis

Tuberculosis incidence and epidemiology, England, 2023

Published 5 December 2024

Applies to England

Main messages

In 2023:

• tuberculosis (TB) notification rates in England in 2023 increased by 11.0% compared with 2022, the largest year-on-year increase in the current reporting period (2000 to 2023)
• England remained below the World Health Organization (WHO) threshold of 10 per 100,000 population for a low incidence country, at 8.5 per 100,000 population in 2023 but the rate diverged further from the trajectory needed to meet the WHO End TB target by 2035
• almost 80% of active TB notified in England was in people born outside the UK in whom rates increased by 7.2% to 40.1 per 100,000 compared with 2022
• the TB notification rate in people born in the UK in 2023 increased by 5.0% compared with 2022, this was the first rate-increase in UK-born individuals with TB UK since 2012 following a decade of continual decline
• the number of individuals born outside the UK notified with TB disease within 5 years of entry to the UK increased by almost 2-fold, compared with 2019; the largest increase was within people notified within 1 to 2 years of entry
• the number of individuals with 2 or more social risk factors increased by 39% compared with 2018; these individuals often experience complex social needs and require enhanced support from services to access healthcare

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 global 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

Global Epidemiology

Globally, the number of people who fell ill with TB increased slightly in 2023 (10.8 million people  compared to 10.7 million in 2022). The estimated global TB incidence rate (new cases per 100 000 population per year) increased by 4.6% between 2020 and 2023, from 129 (95% confidence interval (CI): 121 to 136) in 2020 to 134 (95% UI: 125 to 145) in 2023. Most of the people who developed TB disease in 2023 were in 30 high TB burden countries, which accounted for 87% of the global total.

The recent global rise reflects the ongoing effects of disruptions to TB services during the COVID-19 pandemic and the time lag between more people being infected during that period and the development of TB disease. In 2023, the rate of increase slowed considerably and appears to be levelling off, reflecting strong post pandemic recovery efforts. For further information see WHO Global Tuberculosis Report 2024.

National epidemiology and progress towards the WHO elimination targets

TB in England

In 2023 4,855 people were notified with TB in England, an increase of 11.0% in numbers and notification rate compared with 2022; the largest year-on-year increase in the current reporting period (1971 to 2023). England remained a low TB incidence country with a rate of 8.5 per 100,000 (95% CI: 8.3 to 8.7 per 100,000), below the WHO threshold of 10 per 100,000, but not on track for the WHO elimination target of 2035.

Between 2011 and 2022, TB notifications declined by 52.8% however most of this reduction occurred between 2011 and 2018. After 2018 the rate of decline slowed to a plateau in 2021 and 2022, (with the exception of 2020, when a 13.1 % decrease occurred at the same time as the COVID-19 pandemic) - see Figure 1. A decrease during and rebound after the pandemic is observed in many countries as reported in the WHO Global TB report.

Figure 1. Number of TB notifications and TB notification rate per 100,000, England, 1971 to 2023

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 in England needed to fall from 2015 by 10.9% annually, much greater than the annual rates observed. To meet the 2035 target, a sharp reversal of the current upward trajectory is required followed by a year-on-year decrease of 16% from 2024 onwards. The only year that a decrease close to this magnitude occurred was in 1987 (15.7%).

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 (observed) compared with the rates required for the WHO goal are shown in Figure 3 below. The difference (excess) between the observed and the required rate to meet the WHO goal of 90% reduction by 2035 has increased each year (with the exception of 2020).

Figure 3. Required rates and excess observed TB rates to meet 90% reduction by 2035, England, 2017 to 2023

The data used in this graph can be found in Supplementary Table 3 of the accompanying data set.

Geographical variation in the number and notification rate of people with TB

In 2023, the NHS region with the highest TB notification rate was London at 18.7 per 100,000 population, approximately 5 times higher than the rate in the South West with a rate of 3.7 per 100,000 population (see Table 1). There were no significant changes in rates between 2022 and 2023 for the 7 NHS regions.

Table 1. Number of TB notifications and annual notification rates per 100,000 people by NHS region, England, 2023

NHS region	Number of TB notifications	TB notification rate	Lower CI	Upper CI
London	1,662	18.7	17.9	19.7
Midlands	977	8.9	8.4	9.5
North West	584	7.8	7.2	8.4
South East	539	5.9	5.4	6.5
North East & Yorkshire	471	5.7	5.2	6.3
East of England	410	6.1	5.5	6.8
South West	212	3.7	3.2	4.2

Appendix Figures A1a to A1c show notifications in each of the 9 UKHSA regions over time from 2011 to 2023.

TB notifications and rates by NHS region and by UKHSA region for notifications from 2000 to 2023 are shown in Supplementary Tables 4 and 5 of the accompanying dataset.

Integrated care boards (ICBs) replaced clinical commissioning groups (CCGs) in 2022. TB notifications and rates aggregated for notifications between 2021 and 2023 are presented for both ICBs and CCGs in Supplementary Tables 6 and 7 of the accompanying dataset.

In 2023, 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 (2021 to 2023) by local authority areas (see Figure 4a, 4b and Supplementary Table 8 in the accompanying dataset).

In 2023, 2 local authority districts had a 3-year average notification rate above 40 per 100,000. These were Leicester (40.7 per 100,000) and Newham (40.6 per 100,000). In 2023, Leicester became the local authority district with the highest TB rates in England for the first time. A further 4 local authority areas had rates between 30 and 40 per 100,000. These were Brent (39.1), Ealing (31.6), Harrow (31.1) and Slough (31.1).

Overall, only 4.6% (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, 2021 to 2023

Note: due to small numbers, small local authorities were merged with neighbouring local authorities. City of London is merged with Hackney, and merged rates are presented in this figure.

Figure 4b. Three-year average TB notification rates by local authority district, England, 2021 to 2023

Note: UKHSA region boundaries are outlined in black.

The data used in these figures can be found in Supplementary Table 8 of the accompanying dataset.

Social and demographic characteristics of people with TB in England

Notification rates of TB place of birth (UK versus non-UK born) sex, and age

Notifications in non-UK born individuals accounted for 79.9% of TB diagnoses in 2023, the highest proportion observed in the period since 2000 (see Supplementary Table 9 in the accompanying dataset) and compared with 71.5% in 2017 (see Table 2). The TB notification rate increased (5.0%) in the UK born population compared to 2022, to 2.1 per 100,000, this was the first rate increase observed in this group since 2012. In the non-UK born population notification rates increased by 7.2% to 40.1 per 100,000 in 2023 from 37.4 per 100,000 in 2022 (see Table 2).

Table 2. Proportion of TB notifications in the non-UK born and TB notification rates by place of birth, England, 2017 to 2023

Year	Non-UK born (Percentage)	Non-UK born rate per 100,000	Non-UK born lower CI	Non-UK born upper CI	UK born rate per 100,000	UK born lower CI	UK born upper CI
2017	71.5	41.3	40.0	42.7	3.1	2.9	3.3
2018	72.0	39.0	37.7	40.4	2.7	2.6	2.9
2019	73.7	39.7	38.4	41.1	2.6	2.5	2.7
2020	73.2	36.8	35.5	38.1	2.3	2.2	2.4
2021	77.1	37.5	36.3	38.8	2.1	2.0	2.2
2022	79.0	37.4	36.2	38.7	2.0	1.9	2.1
2023	79.9	40.1	38.9	41.4	2.1	2.0	2.2

The age and sex distribution of people notified with TB in 2023 is shown in Appendix Figure A2a (UK-born) and A2b (non-UK born) and Supplementary Table 10 in the accompanying dataset. People notified with TB in the non-UK-born population tended to be younger with most aged 25 to 34 years, compared with the UK-born with most 65 years and over. The overall proportion of males was 60% male in both populations.

TB notification numbers and rates by age group in the UK-born and non-UK born in 2023 are shown in Appendix Figure A3a and A3b and Supplementary Table 11 in the accompanying dataset. At all ages, TB notification rates are higher in the non-UK born, with much higher rates in young adults, but for young children (aged 0 to 5 years), the number of notifications is greater in the UK-born.

TB notification numbers and rates in the UK-born and non-UK born, from 2000 to 2023,  with year-on-year percentage changes, are shown in Supplementary Table 9 and by UKHSA region over the same period in Supplementary Table 12 of the accompanying dataset, this demonstrates considerable variation in trends over time between regions. In 2023 compared with 2022 the regions with the largest changes tended to be in the low incidence areas.

Countries of birth and time between entry to the UK and TB notification

A key aim of the TB Action Plan is to reduce the proportion of TB cases among individuals born outside the UK within 5 years of entry. Two national screening programmes support this aim:

1. the UK Border Health and Home Office pre-entry screening programme for pulmonary TB
2. the NHS New Entrant Latent TB infection (LTBI) screening programme (post entry)

See TB prevention, England, 2023 for more details. 

Figure 5 shows the proportion of individuals born outside the UK notified with TB, categorised by time since entry to the UK, between 2019 to 2023. The data is presented separately for all TB cases and specifically for pulmonary TB cases.

Figure 5 shows a year-on-year increase in the proportion of individuals born outside the UK who were notified with TB within 5 years of entry to the UK, rising from 22.1% in 2019 to 30.1% in 2023. Between 2019 and 2023, the number of individuals notified within 1 to 2 years of entry nearly doubled. This trend was observed among all people with TB and in people with pulmonary disease. During the same period, there was a 47.3% rise in notifications within 1 year of entry for all TB cases, those with pulmonary disease also increased by 36.5% (see Supplementary Table 13 of the accompanying dataset).

Figure 5. Proportion of notifications (all sites of disease and pulmonary TB (PTB) only) in people born outside of the UK by time since entry to the UK, England 2019 to 2023

Note: denominator includes those with missing data for year of entry to the UK.

The data used in this figure can be found in Supplementary Table 13 of the accompanying data set.

Table 3 presents the country of birth for all people diagnosed with TB in 2023, along with the median time between year of entry to the UK and TB notification. Among those born outside the UK, India was the most common country of birth, continuing a trend observed since 2000 (see Supplementary Table 14 of the accompanying dataset).

For only the second year ever there were more TB notifications in people born in India than in those born in the UK. The most frequent countries of birth for all people notified with TB in 2023 were India, UK, Pakistan, Nigeria, Romania. The median time between TB notification and year of entry to the UK varied by country of birth, with notably shorter durations for Afghanistan, Nigeria and Eritrea (see Table 3).

Table 3. Countries of birth and time between entry to the UK and TB notification, England, 2023

Country of birth	Number of people notified with TB	Proportion of all people notified with TB (Percentage)	Median time since entry to UK in years	Lower quartile	Upper quartile
India	1,166	22.0	3.0	1.0	13.0
United Kingdom	1,116	21.1	0.0	0.0	0.0
Other	881	16.6	8.5	1.4	21.8
Pakistan	563	10.6	10.0	2.0	24.0
Nigeria	196	3.7	1.0	0.0	9.0
Romania	179	3.4	6.0	4.0	8.0
Bangladesh	149	2.8	11.0	2.0	22.0
Afghanistan	148	2.8	1.0	0.0	7.0
Eritrea	142	2.7	2.0	1.0	6.0
Somalia	120	2.3	9.0	1.0	20.0
Philippines	109	2.1	10.0	2.0	19.0
Zimbabwe	109	2.1	5.0	1.0	21.0
Nepal	103	1.9	3.0	0.0	13.0
Sudan	90	1.7	3.0	1.0	5.0
Poland	70	1.3	11.0	8.0	16.0
Sri Lanka	58	1.1	21.0	13.0	25.0
Kenya	54	1.0	22.0	7.0	46.0
Ethiopia	45	0.8	5.0	2.0	13.0

Notes:

• place of birth (UK non-UK) and or country of birth is missing for 16 notifications in 2023
• lower quartile is the 25th percentile and Upper quartile is the 75th percentile representing the inter-quartile range
• 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)
• time since entry to the UK was not known for 688 people

Appendix Figure A4a shows the breakdown of time since entry to the UK for the top 5 countries of birth reported in table 3 above over the period 2018 to 2023. This illustrates that although the median time since entry in 2023 are very different for India and Pakistan, the proportion of people with TB born in those countries notified within 1 and 1 to 2 years since entry to the UK are both increasing and of similar magnitude. The remaining countries of birth with more than 40 notifications in 2023 are shown in Appendix Figure A4b and in Supplementary Table 15 in the accompanying dataset.

Important characteristics of people notified in 2023 born outside of the UK from the 5 most frequent countries of birth are shown in Supplementary Table 16 of the accompanying data set and include mean age, proportion of males, pulmonary TB and proportion of recent entrants notified within 2 years of entry to the UK by site of disease.

Differences in TB notification rates between UK and non-UK born populations of the same ethnic group

Figure 6 shows the number of TB notifications and TB notification rate for 9 different ethnic groupings, separated by place of birth (UK-born compared with non-UK born) in 2023.

In 2023, for people born in the UK, the most common ethnic grouping was White but the notification rate in this group was the lowest (1.5 per 100,000) compared with highest rate in the ‘Black–other’ grouping (15.1 per 100,000).

For individuals born outside of the UK, TB notification rates were higher compared with people of the same ethnic group born in the UK, with the exception of the Black Caribbean ethnic group, which was similar.

The highest notification rate in non-UK born individuals was in the Pakistan ethnic grouping (93.5 per 100,000). The largest difference between UK born individuals and non-UK born individuals was observed for the Indian ethnic group (approximately 13.5 times greater) and the Black African ethnic group (approximately 10.5 times greater) (see Figure 6).

Figure 6. Number (a) of TB notifications and rates (b) in ethnic groups by place of birth (UK and non-UK born), England, 2023

Figure 6 (a)

Figure 6 (b)

The data used in this figure can be found in Supplementary Table 17 of the accompanying data set.

Changes over time in TB notification rates by ethnic groupings and place of birth

Appendix Figure A5 and Supplementary Table 17 of the accompanying data set shows TB notification rates for the 9 different ethnic groupings separated by place of birth, between 2002 and 2023.

Across the whole period notification rates were highest in the non-UK born, ethnic groups: Pakistani, Indian, Black African and Bangladeshi.  

In all non-UK born ethnic groups, a steady decline was observed between 2011 and 2018, after which notification rates plateaued or increased. The only exception to this pattern was observed in non-UK born White ethnic group in whom notification rates steadily increased during the same period with a subsequent decline after 2018 (see Appendix Figure A5).

Across the whole period (2000 to 2023), TB notification rates in all UK-born ethnic groups decreased or were steady. The only exception was for the UK born White ethnic group where a 5% increase was observed in 2023 following 2 decades of continual decline.

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 2023 had pulmonary disease, which may lead to onward transmission (55.0%, 2668 out of 4855) (see Table 4). This proportion is consistent with previous years.

Table 4. TB  notifications by site of disease, England, 2023

Type	Site of disease	Number of notifications	Percentage
Pulmonary	All pulmonary	2,668	55.0
Pulmonary	Miliary	148	3.0
Pulmonary	Laryngeal	15	0.3
Extra-pulmonary	All extra-pulmonary	3,024	62.3
Extra-pulmonary	Extra-thoracic lymph nodes	1,070	22.0
Extra-pulmonary	Intra-thoracic lymph nodes	665	13.7
Extra-pulmonary	Pleural	395	8.1
Extra-pulmonary	Other extra-pulmonary	1,036	21.3
Extra-pulmonary	Gastrointestinal	242	5.0
Extra-pulmonary	Bone – spine	215	4.4
Extra-pulmonary	Bone – not spine	87	1.8
Extra-pulmonary	Central nervous system (CNS) – meningitis	116	2.4
Extra-pulmonary	Genitourinary	70	1.4
Extra-pulmonary	Central nervous system (CNS) – other	60	1.2
Extra-pulmonary	Cryptic disseminated	42	0.9

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 2023.

Risk factors for pulmonary disease

Males, people born in the UK, children and older adults (over 65 years) and people with social risk factors (particularly with a history of imprisonment) are all more likely to have pulmonary TB at the time of diagnosis (see Figure 7 and Supplementary Table 18 of the accompanying data set). The higher risks of pulmonary disease observed in people with a history of imprisonment and in people with social risk factors, are further increased if those individuals are also born outside the UK (see Figure 7).

Figure 7. Risk factors for pulmonary TB disease, England, 2020 to 2023 (aggregate data)

Note: reference groups for RRs in the order presented in the above figure are: aged 15 to 44 years old, no history of imprisonment, female, no SRFs.

Data underlying this figure are available in Supplementary Table 18 of the accompanying dataset.

Comorbidities 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 2023, 25.9% (1257 out of 4855) of all people with TB were known to have at least one co-morbidity, compared to 21.2% in 2022.

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 11.5% in 2023 (Table 5a) followed by immunosuppression (9.0%). 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 2023, 94.4% (4,581 out of 4,855) 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 2023, HIV coinfection was recorded in 3.5% of individuals with TB, this proportion is consistent with recent years. In 2023 the proportion of individuals co-infected with hepatitis B or C was 2.9% and those coinfected with HIV and hepatitis B or C was 0.2%, unchanged since 2021. Although the numbers are small, hepatitis B and C co-infection in people with TB has been increasing steadily since recording began, from 61 (1.1%) notifications in 2015 to 140 (2.9%) notifications in 2023, an almost 3-fold rise. This increase may, in part, result from increased testing and therefore ascertainment.). 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 2023

Comorbidity	Number of people with TB	Proportion (%)	Total with data recorded
Diabetes	518	11.5	4,502
Chronic liver disease	65	1.5	4,441
Chronic renal disease	127	2.8	4,465
Hepatitis B	93	2.2	4,262
Hepatitis C	54	1.3	4,263
Immunosuppression	400	9.0	4,454

Table 5b. Causes of immunosuppression co-morbidity in people with TB, England, 2023

Reason for immunosuppression	Number of people with TB	Proportion (%)	Total with data recorded
Biological therapy	74	18.5	400
Transplantation	24	6.0	400
Cancer	87	21.8	400
Steroids	24	6.0	400
Other or not known immunosuppression	193	48.3	400

Note: people may have more than one comorbidity recorded and more than one reason for immunosuppression. Reason for immunosuppression was missing for 6 individuals.

Cigarette smoking

Smoking increases the risk of contracting TB and impairs the response to treatment. In 2023, 23.0% of people had a history of smoking (992 out of 4,309), and the prevalence of current smoking was 15.4 % (662 out of 4309). 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.

NTBS 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
• asylum seeker status

Unless otherwise stated, the following analyses exclude children under 15 years (140 notifications), leaving 4,715 notifications in the analysis for 2023. 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 in the Methodology and definitions chapter.

Proportions of people with TB and social risk factors

In 2023, there were 811 people notified (17.2%) with one or more SRFs (see Table 6). This is a rise of 26.7% in the number since the beginning of the reporting period in 2018 (14.3%) (see Supplementary Table 20 in the accompanying data set). 

The number of individuals with TB who are recorded as having 2 or more SRFs at the time of notification increased in 2023 to 331 (7.5%) individuals, compared to 239 individuals (5.5%) in 2018; an increase of almost 40%. However, increasing data completion over time may underlie this apparent increase and should be interpreted with caution.

For all people with TB notified in 2023, homelessness was the most common SRF, experienced by 7% of people with TB (see Table 6) followed by being an asylum seeker at 6.4%, or 7.9% when  limited to people born outside of the UK (see Supplementary Table 20 in the accompanying dataset).

Table 6. Proportions of people aged 15 or more with individual social risk factors (SRFs), England 2023

Social risk factor	Number of people with TB	Total with data reported	Proportion (%)
Drug misuse (current or previous)	217	4,272	5.1
Alcohol misuse (current)	214	4,302	5.0
Homelessness (current or previous)	282	4,282	6.6
Prison (current or previous)	178	4,216	4.2
Asylum seeker (current)	278	4,326	6.4
Mental health needs (current)	157	4,231	3.7
One or more SRF	811	4,715	17.2
Two or more SRFs	331	4,399	7.5

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 21 of the accompanying data set shows the number and proportions of people aged 15 years or more with at least one SRF recorded by UKHSA region by year for 2018 to 2023. In 2023, this ranges from 16% (83 out of 525) in the South East to 21% (23 out of 110) in the North East. London had the highest number of people with at least one SRF reported (291 out of 1614 people, 18%)

Characteristics associated with having one or more social risk factors

Figure 8 and Supplementary Table 22 show that UK born males with TB were 2 and a half times more likely than females to have one or more SRFs (risk ratio (RR) 2.56, 95% CI: 2.11 to 3.01) and that this risk was higher in people born outside of the UK (RR 3.04, 95% CI: 2.67 to 3.42). Being unemployed was also associated with an approximately 2-and-a-half-fold increased risk but was similar in both UK born and non-UK born individuals. Older adults (more than 65 years) with TB were less likely to have an SRF compared to younger adults (age 15 to 44 years), whilst middle aged people (45 to 64 years) had a lower risk if they were born outside of the year and a higher risk if UK-born.

Figure 8. Relative risks of factors associated with having one or more SRFs in people notified with TB between 2020 to 2023 (aggregate data), England, 2023

Notes:

• only those aged 15 years or older were included in Figure 8
• reference groups for RRs in the order presented in the above figure are: employed, female, and aged 15 to 44 years old

Data underlying this figure can be found in Supplementary Table 22 of the accompanying dataset.

Prevalence of social risk factors by place of birth, age and ethnicity

Figure 9 shows the breakdown for the 6 SRFs by age group and place of birth (UK and non-UK born) for people notified in 2023 and illustrates how the prevalence of different SRFs by age is different in people born in or outside of the UK. Being an asylum seeker was the most prevalent SRF for younger aged non-UK born people, affecting 137 people (24.7%) of those aged 15 to 24, compared with 14 people (1.5%) of those aged 45 to 64. Homelessness and history of imprisonment were also more common in the youngest age group for people born in the UK compared to those aged 25 to 44, and 45 to 64 in people born in the UK.

Figure 9. Social risk factors by age and place of birth (UK-born or non-UK born), England, 2023

Data underlying this figure can be found in Supplementary Table 23 of the accompanying dataset.

Supplementary Table 24 of the accompanying data set shows the proportions of SRFs by ethnicity, for those born in the UK, and by country of birth for those born outside the UK. The prevalence of SRFs vary by ethnicity in the UK born population with TB. Between 2018 to 2023, 51 people (4.4%) of those identified as South Asian reported 2 or more social risk factors compared to 65 people (21.3%) of those identified as Black-Caribbean.

In people born outside of the UK with TB, 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 48.6% (353 people) and 52.2% (190 people). This resulted from the high proportion who were asylum seekers and/or homeless.

TB notification rate increased with increased levels of deprivation

In 2023, the rate of TB was 15.7 per 100,000 in the 10% of the population living in the most deprived areas, compared with only 3.3 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 (see Figure 10).

Figure 10. TB notification rate by deprivation decile, England, 2023

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 25 of the accompanying data set.

Appendix

Figure A1a Number of TB notifications (i) and rate (ii) by UKHSA region for London, 2011 to 2023

Figure A1a (i)

Figure A1a (ii)

Figure A1b. Number (i) and rates (ii) of TB for West Midlands, South East, North West and East of England UKHSA regions 2012 to 2023

Figure A1b (i)

Figure A1b (ii)

Figure A1c. Number (i) and notification rates (ii) of TB for East Midlands, Yorkshire and Humber, South West and North East UKHSA regions, 2012 to 2023

Figure A1c (i)

Figure A1c (ii)

Data used in these figures is available in Supplementary Table 5 of the accompanying data set.

Figure A2a. Age and sex distributions by place of birth for UK-born people, 2023

Figure A2b. Age and sex distributions by place of birth for non UK-born people, 2022

Data used in this figure is available in Supplementary Table 10 of 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, 2023

Figure A3 (a)

Figure A3 (b)

Data used in this figure is available in Supplementary Table 11 of the accompanying data set.

Figure A4a. Number of notifications by time since entry (years) to the UK for the 5 countries of birth with the highest number of notifications, 2018 to 2023 (scale varies)

Figure A4b. Number of notifications by time since entry (years) to the UK for by country of birth, 2018 to 2023

Notes:

• countries shown in Appendix Figure A4a are the 5 countries of birth with the highest number of notifications in 2023
• countries shown in Appendix Figure A4b include those with more than 40 notifications in 2023 and are not included in the Appendix Figure A4a of the 5 most frequent countries of birth in 2023
• where bars do not add up to 100%, this is due to missing data on year of entry to the UK

Data used in this figure is available in Supplementary Table 15 of the accompanying data set.

Figure A5. Rates of TB in UK and non-UK born by ethnic group, England, 2002 to 2023

Data used in this figure is available in Supplementary Table 17 of the accompanying data set.