Tuberculosis rates in the UK are still unacceptably high. Public Health England notes in its annual UK report that 7892 cases of tuberculosis were notified in 2013, a decrease from 8729 cases reported in 2012. However, the incidence of 12·3 cases per 100 000 is still among the highest in western European countries. Another sobering comparison is that the incidence in the UK is four times that of the USA.
Long recognised as a disease of social inequality and deprivation, according to the report, tuberculosis continues to disproportionately affect the most deprived communities, with 70% of all tuberculosis cases in England resident in areas in the two most deprived quintiles. In particular, the urban areas of London, Leicester, Birmingham, Luton, Manchester, and Coventry had more than three times the national average. Within London alone, 2985 cases were reported in 2013, an incidence of 35·5 cases per 100 000. 44% of patients aged 16 and older were not in education or employment, and 10% had at least one social risk factor—history of alcohol or drug misuse, homelessness, or imprisonment. 73% of the cases were in people born outside the UK, but only 15% were diagnosed within 2 years of entering the UK, suggesting a preponderance of reactivation of latent tuberculosis infection.
These data indicate the different demographics of the disease in the UK compared with other countries, but also a disjointed, fragmented approach to local tuberculosis services, and their funding. As noted in the report, improvements in tuberculosis control will need the social and economic determinants of the disease to be addressed, together with the provision of strong, accessible, effective screening, diagnostic, and treatment services, clearly targeted at the most susceptible groups. Public Health England and NHS England will soon publish a Collaborative TB Strategy for England 2015–2020, which will identify the key areas to achieve a sustained decline in tuberculosis. Although small gains have been made, it is essential the strategy enables firm steps to be taken to achieve a level of control that exists elsewhere.