Increasing incidence of tuberculosis in England and Wales: a study of the likely causes.

OBJECTIVE--To examine factors responsible for the recent increase in tuberculosis in England and Wales. DESIGN--Study of the incidence of tuberculosis (a) in the 403 local authority districts in England and Wales, ranked according to Jarman score, and (b) in one deprived inner city district, according to ethnic origin and other factors. SETTING--(a) England and Wales 1980-92, and (b) the London borough of Hackney 1986-93. MAIN OUTCOME MEASURE--Age and sex adjusted rate of tuberculosis. RESULTS--In England and Wales notifications of tuberculosis increased by 12% between 1988 and 1992. The increase was 35% in the poorest 10th of the population and 13% in the next two; and in the remaining 70% there was no increase. In Hackney the increase affected traditionally high risk and low risk ethnic groups to a similar extent. In the "low risk" white and West Indian communities the incidence increased by 58% from 1986-8 (78 cases) to 1991-3 (123), whereas in residents of Indian subcontinent origin the increase was 41% (from 51 cases to 72). Tuberculosis in recently arrived immigrants--refugees (11% of the Hackney population) and Africans (6%)--accounted for less than half of the overall increase, and the proportion of such residents was much higher than in most socioeconomically deprived districts. The local increase was not due to an increase in the proportion of cases notified, to HIV infection, nor to an increase in homeless people. CONCLUSIONS--The national rise in tuberculosis affects only the poorest areas. Within one such area all residents (white and established ethnic minorities) were affected to a similar extent. The evidence indicates a major role for socioeconomic factors in the increase in tuberculosis and only a minor role for recent immigration from endemic areas.     

Association between incidence of non-Hodgkin's lymphoma and solar ultraviolet radiation in England and Wales.

OBJECTIVES--To examine whether the incidence of non-Hodgkin''s lymphoma in different areas of England and Wales is associated with levels of solar ultraviolet radiation. DESIGN--Geographically based study examining the association between incidence of non-Hodgkin''s lymphoma and estimated levels of solar ultraviolet radiation, controlling for social class and employment in agriculture. SETTING--59 counties in England and Wales. SUBJECTS--All registered cases of non-Hodgkin''s lymphoma during the period 1968-85. MAIN OUTCOME MEASURE--Age and sex adjusted odds ratio for non-Hodgkin''s lymphoma in each county. RESULTS--Incidence of non-Hodgkin''s lymphoma was significantly associated with solar ultraviolet radiation levels (P < 0.001), even after social class and employment in agriculture were controlled for (P = 0.004). In a comparison of counties in the highest and lowest quarters of solar ultraviolet radiation, the relative risk of non-Hodgkin''s lymphoma was 1.27 (95% confidence interval 1.24 to 1.29), rising to 1.34 (1.32 to 1.37) after adjustment for social class and employment in agriculture. CONCLUSIONS--The incidence of non-Hodgkin''s lymphoma in different areas of England and Wales is positively associated with levels of solar ultraviolet radiation. These results are consistent with the hypothesis that exposure to solar ultraviolet radiation increases the risk of non-Hodgkin''s lymphoma.     

Regional variations in the incidence of upper urinary tract stones in England and Wales.

Data from the Hospital In-patient Enquiry were used to define the regional patterns of hospital discharge rates for upper urinary tract stones and renal colic in England and Wales. By combining the rates for stones and colic, and by distinguishing emergency from planned admissions, the biases produced by repeated admissions of the same patient and by regional variations in diagnosis and coding may be reduced. There are regional variations in incidence of upper urinary tract stones: Wales and the southern regions of England have a generally higher incidence than northern regions. These variations may be related to regional differences in diet or occupation; or they may partly depend on associations between stone incidence and atmospheric temperature, exposure to ultraviolet irradiation, and hardness of drinking water.     

Environmental temperatures and the incidence of food poisoning in England and Wales

The incidence of food poisoning in England and Wales has been increasing for many years and it is now a major public health problem. Superimposed on this general rising trend is a well-established tendency for the number of cases of food poisoning to rise during the summer when warm weather favours the multiplication of pathogenic micro-organisms. This paper shows that weekly notifications of food poisoning in England and Wales are strongly associated with environmental temperatures, but that there are some important time lags in this relationship. The number of cases of food poisoning in a given week was only weakly correlated with the temperature of that week and the one preceding it. This suggests that factors operating close to the point of consumption within or outside the home are not the principal cause of the rise in food poisoning associated with warm summer conditions. There was a much stronger association with temperatures 2–5 weeks earlier, pointing to the importance of factors operating earlier in the food production or distribution system. The results of this study suggest that the food poisoning problem requires action by food producers and distributors as well as by consumers. Received: 15 May 2000 / Revised: 17 October 2000 / Accepted: 18 October 2000     

Climate change and the incidence of food poisoning in England and Wales

In recent years there have been several spells of high temperatures providing analogues for the conditions that might become more common as a result of the enhanced greenhouse effect. Statistical models were developed of the relationship between the monthly incidence of food poisoning and temperatures and these were then used to provide estimates of the possible effects of future warmer summers. Routinely collected data on the number of reported cases of food poisoning were analysed for the years 1982–1991. Regression analysis was used to establish the relationship between the monthly incidence of food poisoning and temperatures of the same and the previous month. Published scenarios for future temperatures were applied to these statistical models to provide estimates of the possible impacts of warmer conditions. The monthly incidence of food poisoning was found to be significantly associated with the temperature of the same and of the previous month with the latter having the stronger effect. Using published data on the relationship between reported and actual numbers of cases of food poisoning, it is estimated that annually there might be an additional 179 000 cases of food poisoning by the year 2050 as a result of climate change. The observed relationship with the same month's temperature underlines the need for improvements in storage, preparation and hygiene close to the point of consumption. However, there was a much stronger relationship with the temperature of the previous month, indicating the importance of conditions earlier in the food production process. Improvements in areas such as animal husbandry and slaughtering may also be necessary to avoid the adverse effects of a warmer climate.