National survey of tuberculosis notifications in England and Wales in 1983: characteristics of disease. Report from the Medical Research Council Tuberculosis and Chest Diseases Unit

Abstract

The number of newly notified, previously untreated patients in a survey of notifications of tuberculosis in England and Wales conducted by the MRC in 1983 was 26% lower than in the previous MRC survey in 1978/79. In both surveys the great majority of patients were of White (about half) or Indian subcontinent (Indian, Pakistani or Bangladeshi) ethnic origin (just over a third). The notification rates in the Indian subcontinent (ISC) ethnic groups were much higher than for the White group and were highest in those most recently arrived in the UK. There were a number of differences in the findings for the White and the ISC ethnic groups. Nearly two-thirds of the White patients but less than half of the ISC patients were male and the White patients were, on average, older, about half aged 55 years or more compared with 14% of the ISC patients. Respiratory disease occurred in 82% of the White patients compared with 66% of the ISC patients. Radiographically, at independent assessment, more of the White patients had pulmonary lesions, 88% compared with 63% and these were, on average, more extensive and cavitated than in the ISC patients. Isolated mediastinal lymphadenopathy, however, was more common in the ISC patients. The diagnosis was confirmed bacteriologically on culture of a respiratory specimen in a higher proportion of the White than the ISC patients (65% and 41% respectively) and more were positive on smear as well (45% and 25% respectively). The level of initial drug resistance was lower in the White patients: only 10 (1.6%) of the 623 strains tested were resistant compared to 23 (12.8%) of the 179 from ISC patients. In both White and ISC ethnic groups the commonest non-respiratory lesion was peripheral lymph node involvement, namely 37% of the 369 White and 53% of the 503 ISC patients with non-respiratory disease. The diagnosis was confirmed by bacteriological examination of the lymph node in 47% of the ISC patients compared with 29% of the White patients with a lesion. Bone or joint disease occurred in 11% of the White and 20% of the ISC patients; the commonest site in both groups was the spine. Genitourinary disease was present in 98 (27%) of White and 24 (5%) of ISC patients with a non-respiratory lesion. There were 61 patients with tuberculosis involving the central nervous system, including 55 with meningitis, the proportions being similar for the White and the ISC ethnic groups, 7% and 5% respectively.