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Free Content Decreasing tuberculosis case fatality in England and Wales, 1988–2001

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SETTING: Despite declining tuberculosis mortality per head of population, there was little change in tuberculosis case fatality in England and Wales from 1974 to 1987.

OBJECTIVE: To determine the trend in tuberculosis case fatality for England and Wales from 1988 to 2001.

DESIGN: Annual deaths to notifications ratios (DNRs) for tuberculosis were calculated using published notification and mortality data, and analysed by age group and three disease sites (central nervous system [CNS], respiratory and other). DNRs for seven disease sites (miliary, bone and joint, CNS, respiratory, genitourinary, gastrointestinal and other) were calculated for 1998 and 1999 combined, using additional data from the enhanced tuberculosis surveillance programme.

RESULTS: DNR for all ages and disease sites combined fell from 9.26% in 1988 to 5.59% in 2001 (r = −0.90; 95%CI −0.97–−0.70). DNRs for 1998–1999 combined were 41% for miliary disease, 17% for bone and joint disease, 8% for CNS disease, 7% for respiratory disease, 2% for genitourinary and gastrointestinal disease and 0.6% for other disease.

CONCLUSIONS: Some of the decrease in DNRs may be due to improving notification rates. True declines in overall case fatality reflect increases in the proportion of tuberculosis patients in younger age groups and with low mortality extra-pulmonary disease.
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Keywords: England; Wales; case fatality; mortality; tuberculosis

Document Type: Regular Paper

Affiliations: 1: Newham Chest Clinic, Shrewsbury Centre, London, United Kingdom 2: North West Public Health Observatory, John Moores University, Liverpool, United Kingdom 3: Tuberculosis Research and Resources Unit, Cardiothoracic Centre, Liverpool, United Kingdom

Publication date: 01 June 2004

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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