IngentaConnect Historical declines in tuberculosis in England and Wales: improvi...

Authors: R.P.O. Davies¹; K. Tocque²; M.A. Bellis²; T. Rimmington²; P.D.O. Davies¹

Source: The International Journal of Tuberculosis and Lung Disease, Volume 3, Number 12, December 1999 , pp. 1051-1054(4)

Publisher: International Union Against Tuberculosis and Lung Disease

Abstract:

OBJECTIVES: A reinvestigation of the relationship between the decline of tuberculosis and improvement in social conditions in England and Wales during Victorian times.

DESIGN: A retrospective study using data published in the annual reports of the Registrar General from 1853 to 1910.

MEASURES ASSESSED: The diseases studied, in addition to tuberculosis were dysentery and cholera, including their total and infant mortality. Social conditions were evaluated from earnings and population density per house.

RESULTS: Tuberculosis mortality declined at an annual average rate of 1.71% (95% confidence interval [CI] 0.77–2.63), whereas total mortality, infant mortality and mortality from cholera and dysentery and house population density showed no statistically significant decline over the same period. Real earnings increased by 1.05% (95% CI 0.29–1.81).

CONCLUSION: Improving social conditions do not provide the total explanation for the decline in tuberculosis during Victorian times. Other factors, principally natural selection, probably played a role. Part of the current increase in tuberculosis may be caused by effective drug therapy eliminating natural selection.

Keywords: tuberculosis; mortality; social conditions; historical

Document Type: Miscellaneous

Affiliations: 1: Tuberculosis Research Unit, Cardiothoracic Centre, Liverpool, United Kingdom 2: CDSC (North West), Public Health Laboratory, Fazakerly Hospital, Liverpool, United Kingdom

Historical declines in tuberculosis in England and Wales: improving social conditions or natural selection? [Unresolved Issues]