Research and analysis

1. Tuberculosis incidence and epidemiology, England, 2024

Published 9 October 2025

Applies to England

Main messages

1. Tuberculosis (TB) notification numbers in England increased by 13.6% in 2024 compared to 2023 - the largest annual increase since national surveillance began.
2. England remains just under the World Health Organization (WHO) threshold of 10 notifications per 100,000 (9.4) but at current rates of increase England will pass this threshold by the end of 2025.
3. Rates continue to be highest in London and the Midlands and in those living in the most deprived areas of England.
4. 81.9% of notifications were in people born outside the UK, similar to 2023 (80.0%).
5. Rates increased in people born in the UK by 5.0% in 2024, only the second year-on-year increase since enhanced surveillance started in 2012.
6. 1 in 7 TB notifications reported one or more social risk factors with the most common being homelessness, asylum seeker status and drug use.
7. The number of individuals born outside the UK with a diagnosis made within 5 years of entry increased by 23.2% in 2024. Those diagnosed who were within 1 to 2 years of entry increased by 42.4% since 2023, representing a doubling since 2022. This likely reflects the increased migration from higher incidence countries and effects of global disruptions in TB care due to the COVID-19 pandemic.

Supplementary tables

Data relating to this chapter can be found in the 26 supplementary data tables in the accompanying spreadsheet, Tuberculosis incidence and epidemiology, supplementary tables, which is available to download.

International context

Globally, in 2023 TB returned to being the leading cause of death from a single infectious agent, with over 10 million people falling ill and 1.4 million dying from the disease. Despite being preventable and usually curable, global rates of TB have remained high, placing the heaviest burden on the poorest and most vulnerable populations, further widening existing health inequalities.

In 2015, the WHO established the global ‘End TB’ strategy. The political declaration adopted by the World Health Assembly provides a blueprint to end the TB epidemic by 2035. The strategy sets out a series of targets for countries to:

• reduce TB deaths by 95%
• reduce new TB notifications by 90%
• eliminate the catastrophic costs faced by TB-affected families

Global epidemiology

The most recent data published by WHO up until the end of 2023 indicates the number of people who fell ill with TB increased slightly since the previous year (10.8 million versus 10.7 million in 2022). This is thought to reflect the ongoing recovery in a backlog of case detection post-COVID-19 due to disruptions to TB services globally.

A total of 30 high TB burden countries accounted for 87% of the global total of notifications in 2023. Five countries accounted for over half of all notifications worldwide: India (26%), Indonesia (10%), China (7%), the Philippines (7%) and Pakistan (6%).

Global TB deaths continued a slow decline, with 1.25 million deaths in 2023 (including 161,000 among people with HIV), down from 1.32 million in 2022.

National epidemiology and progress towards WHO elimination targets

TB in England

In 2024, there was a 13.6% increase in the number of TB notifications in England, from 4,831 in 2023 to 5,490. TB incidence (per 100,000 population) increased from 8.3 to 9.4 (95%, confidence interval (CI): 9.3 to 9.8), remaining just below the WHO threshold of 10 for a low incidence country (Figure 1).

Figure 1. Number of TB notifications and TB notification rate per 100,000, England, 2000 to 2023

The data used in this graph can be found in Supplementary Table 1 of the accompanying spreadsheet.

With year-on-year increases of over 10% since 2022, the trajectory of TB incidence in England indicates that the WHO low incidence threshold is likely to be breached in 2025 (Figure 2).

To meet the WHO ‘End TB’ goal of a 90% reduction in incidence by 2035, an annual decline of 18.1% is required for the next 11 years (Figure 2). Since 2018, the gap between the trajectory required to meet this target and the observed trajectory has widened significantly (Figure 3).

Figure 2. Observed rates of decrease in TB notification in England from 2010 to 2035 compared with required rate of decrease to achieve the WHO ‘End TB’ goal of a 90% reduction in TB incidence from 2015 to 2035

Notes to Figure 2:

• the WHO defines the pre-elimination threshold as a notification rate of 1 case per 100,000 population
• the WHO defines the low-incidence threshold as a notification rate of 10 cases per 100,000 population
• to achieve a 90% reduction from the 2015 baseline by 2035, the required average annual decline is 18.1 %

The data used in this graph can be found in Supplementary Table 2 of the accompanying spreadsheet.

Figure 3. Required rates and excess observed TB rates to meet 90% reduction by 2035, England, 2016 to 2024

The data used in this graph can be found in Supplementary Table 3 of the accompanying spreadsheet.

Geographical variation in the number and notification rate of people with TB

London continued to report the highest TB notification rate of any UK Health Security Agency (UKHSA) region per 100,000 in 2024 (20.6, CI:19.7 to 21.6) and was the only region to report a significant increase in rate compared to 2023 (18.3; CI:17.5 to 19.3). The second highest rate was reported by the West Midlands (11.5 (CI:10.6 to 12.3)) followed by the North West (8.7 (CI: 8.0 to 9.3) and East Midlands (8.5 (CI: 7.9 to 9.3)) (Table 1).

Table 1. Number of TB notifications and annual notification rates per 100,000 people by UKHSA region, England, 2024

UKHSA region	Number of notifications	Notification rate per 100,000	Lower CI	Upper CI
London	1,876	20.6	19.7	21.6
West Midlands	709	11.5	10.7	12.4
North West	658	8.5	7.9	9.2
South East	587	6.3	5.8	6.8
East of England	447	6.5	5.9	7.1
East Midlands	422	8.3	7.5	9.1
Yorkshire and the Humber	422	7.4	6.7	8.1
South West	246	4.2	3.7	4.8
North East	123	4.5	3.8	5.4

Notes to Table 1:

• Appendix Figures A1a to A1c show notifications in each of the 9 UKHSA regions over time from 2011 to 2024
• TB notifications and rates by NHS region and UKHSA region for notifications from 2000 to 2024 are shown in Supplementary Tables 4 and 5 of the accompanying data set
• TB notifications and rates aggregated for notifications between 2022 and 2024 are presented for integrated care boards (ICBs) and ICB sub-localities in Supplementary Tables 6 and 7 of the accompanying data set

In 2024, no ICBs or ICB sub-localities achieved the WHO pre-elimination target rate of less than 1 per 100,000. A quarter of ICBs had rates above 10 per 100,000 (26.2%, 11 out of 42). The main burden of disease remains concentrated in large urban areas, which is demonstrated best by 3-year average notification rates (2022 to 2024) by local authority areas (see Figures 4a, 4b and Supplementary Table 8 in the accompanying data set).

In 2024, 2 local authorities had a 3-year average notification rate above 40 per 100,000: Leicester (42.1) and Newham (41.4). Five local authorities had rates between 30 and 40 per 100,000: Brent (39.1), Harrow (35.0), Ealing (33.6), Slough (32.8) and Hounslow (31.5 ).

Figure 4a. Three-year average TB notification rates by local authority district in London, England, 2022 to 2024

Note to Figure 4a: due to small numbers, small local authorities were merged with neighbouring local authorities. City of London is merged with Hackney, and merged rates are presented in this figure.

Figure 4b. Three-year average TB notification rates by local authority district, England, 2022 to 2024

Note to Figure 4b: UKHSA region boundaries are outlined in black.

The data used in these figures can be found in Supplementary Table 8 of the accompanying data set.

Social and demographic characteristics of people with TB

Notification rates of TB by place of birth, sex and age

People born outside the UK accounted for 81.9% (4,490 out of 5,484) of TB notifications in 2024 compared to 80.0% in 2023. This represents an increase of over 8% since 2020 (see Supplementary Table 9.5 in the accompanying data set). TB notification rates continued to be much higher in those born outside the UK compared with those born in the UK in 2024 (46.9 versus 2.1 per 100,000 population) and increased by 12.4% from 2023 (41.3 per 100,000 (CI: 40.0 to 42.6)) (Table 2).

People diagnosed with TB and born outside the UK had a median age of 36, and 60.7% (2,725 out of 4,489) were male. The highest proportion of notifications were in people aged 25 to 34 years old (31.6%, 1,417 out of 4,489) followed by those aged 35 to 44 (19.9%, 893 out of 4,489) and 15 to 24 years old (14.0%, 629 out of 4,489). The highest notification rates per 100,000 population were reported in those aged 25 to 29 years old (103.3) followed by 20 to 24 years (85.8) and over 80 years (49.2).

In people born in the UK with TB, the median age was 43 and 61.3% (609 out of 994) were male. The highest proportion of notifications were in people aged over 65 years (19.4%, 193 out of 994) followed by those aged 55 to 64 years (15.4%, 153 to 994) and 35 to 44 years (14.4%, 143 out of 994). The highest notification rates per 100,000 population were reported in those aged 25 to 29 years old (3.1) followed by 40 to 44 (3.0) and 20 to 24 (2.7).

Rates and age and sex distribution of people notified with TB in 2024 can be found in Appendix Figure A2a (UK born) and A2b (non-UK born), and in Supplementary Tables 10 and 11 in the accompanying data set.

Table 2. Proportion of TB notifications in the non-UK born and TB notification rates by place of birth, England, 2019 to 2024

Year	Non-UK born (percentage)	Non-UK born rate per 100,000	Non-UK born lower CI	Non-UK born upper CI	UK born rate per 100,000	UK born lower CI	UK born upper CI
2016	73.8	49.0	47.5	50.5	3.1	2.9	3.3
2017	71.5	41.9	40.5	43.3	3.1	2.9	3.3
2018	72.0	38.5	37.2	39.8	2.7	2.6	2.9
2019	73.7	39.6	38.3	40.9	2.6	2.5	2.8
2020	73.2	34.2	33.0	35.4	2.3	2.2	2.4
2021	77.1	37.7	36.4	39.0	2.1	2.0	2.2
2022	79.0	37.8	36.6	39.1	1.9	1.8	2.0
2023	80.0	41.3	40.0	42.6	2.0	1.9	2.1
2024	81.9	46.9	45.5	48.3	2.1	2.0	2.2

TB notification numbers and rates in the UK born and non-UK born, from 2000 to 2024, with year-on-year percentage changes, are shown in Supplementary Table 9 and by UKHSA region over the same period in Supplementary Table 12.5 of the accompanying data set.

TB notification numbers and rates by age group in the UK-born and non-UK born in 2023 are shown in Appendix Figures A3a and A3b and in Supplementary Table 11.5 in the accompanying data set.

Countries of birth and time between entry to the UK and TB notification

The national TB Action Plan (2021 to 2026) sets out a key objective to reduce the proportion of active TB notifications in people born outside the UK within 5 years of their arrival by 5.0% each year using the 2017 to 2019 average as a baseline. There are 2 national screening programmes that support this target:

1. Pre-entry active pulmonary TB screening led by the UK Border Health and Home Office.
2. Post-entry latent TB infection (LTBI) testing and treatment delivered by the NHS.

(For more information see the TB Prevention chapter in this report).

TB notifications in people born outside the UK by time of entry show significant changes over the last 5 years. The proportion of notifications within 5 years of entry has increased from 31.3% in 2021 to 41.1% in 2024. The proportion of notifications within the first 3 years of entry in particular increased from 20.1% in 2021 to 30.8% in 2024. This pattern was also observed for pulmonary TB notifications which increased from 9.7% in 2021 to 14.8% in 2024 (see Figure 5 and Supplementary Table 13).

Figure 5. Proportion of notifications (all sites of disease and pulmonary TB (PTB) only) in people born outside of the UK by time since entry to the UK, England 2020 to 2024

Among TB notifications in people born outside the UK, the highest proportion were from India (33.3%, 1,495 out of 4,495) followed by Pakistan (13.7%, 618 out of 4,495), Nigeria (4.6%, 208 out of 4,495) and Romania (3.8%, 173 out of 4,495) (see Supplementary Table 14).

For those entering the UK from India, the median time from entry to notification was 2 years compared to 9 years for those from Pakistan, 2 years for those from Nigeria and 7 years for those from Romania (see Supplementary Table 15).

For people entering from India, the proportion notified within 5 years of entry has increased from 30.7% in 2019 to over 60% in 2024 (62.3%, 931 out of 1,495). For those entering from Pakistan, the proportion notified within 5 years of entry also increased from 22.9% in 2019 to 39.5% (244 out of 618) in 2024 (see Supplementary Table 16).

Appendix Figure A4a shows the breakdown of time since entry to the UK for the top 5 countries of birth. The remaining countries of birth with more than 40 notifications in 2023 are shown in Appendix Figure A4b and in Supplementary Table 16 in the accompanying data set.

Key characteristics of people notified in 2024 born outside of the UK from the 5 most frequent countries of birth are shown in Supplementary Table 17 of the accompanying data set. They include mean age, proportion of males, pulmonary TB and proportion of recent entrants notified within 2 years of entry to the UK by site of disease.

Figure 6. Countries of birth and median time between entry to the UK and TB notification, England, 2024

Notes to Figure 6:

• place of birth (UK or non-UK) and or country of birth is missing for 6 notifications in 2024
• lower quartile is the 25th percentile and upper quartile is the 75th percentile representing the inter-quartile range
• time between entry to the UK and TB notification is calculated as whole years (only year of entry is reported to National TB Surveillance (NTBS)
• time since entry to the UK was not known for 476 people in 2024

Differences in TB notification rates between UK and non-UK born populations of the same ethnic group

TB rates by ethnicity and country of birth show that in people born outside the UK, those of Indian ethnicity had the highest rate per 100,000 population (119.6) followed by Pakistani (123.3), Bangladeshi (64.7) and Black African (74.0).

For people born in the UK the highest rate was observed in those of Pakistani ethnicity (13.5) followed by Black-other (12.3) , Black-African (12.1), Bangladeshi (9.6) and Indian (9.5) (see Figure 7b and Supplementary Table 18.5).

The largest difference in rates between ethnic groups that were born outside the UK versus in the UK was observed in those of Indian ethnicity, where rates were around 12.5 times higher, followed by Pakistani (9 times higher), Bangladeshi (7 times higher), and mixed/other (7.5 times higher) (see Figures 7a and 7b).

Figure 7a. Number of TB notifications by place of birth and ethnicity, England, 2024

Figure 7b. TB notification rates per 100,000 population by place of birth and ethnicity, England, 2024

Note on Figures 7a and 7b: this is the first data release produced using the new Office for National Statistics (ONS) Annual Population Survey (APS) methodology, replacing the previous ONS Labour Force Survey (LFS) approach. A comparison of the 2 methods is provided in Supplementary Tables 18 and 18.5.

Further information about the changes can be found on the Methods and definitions section of this report.

The data used in this figure can be found in Supplementary Table 18.5 of the accompanying data set.

Changes over time in TB notifications and notification rates by ethnic groupings and place of birth

Overall TB notification rates (per 100,000 population) among those born outside the UK has been on an upward trend since 2018 (38.5 versus 46.9 in 2024). However, this pattern does not apply to each ethnic group (see Supplementary Table 9.5). The largest increases in rates were observed amongst those born outside the UK from 2018 to 2024 of Pakistani ethnicity (+33.6) followed by Indian (+23.6) and Bangladeshi (+11.2). Notification rates amongst those of White, Chinese or Black-Caribbean ethnicity were broadly stable over the same period. Those of Black-other ethnicity had the largest decrease in rate over the period (-21.9) followed by Mixed/other (-20.5) and Black-African (-17.9) (see Appendix Figure A5 and Supplementary Table 18.5).

Clinical characteristics of disease

Site of disease

The site of TB disease determines how infectious an individual may be, the symptoms experienced, potential complications and clinical management strategies. In 2024, just over 50% of individuals notified with TB reported a pulmonary site of disease (54.3%, 2,983 out of 5,490) which is consistent with previous years (Table 3).

Table 3. TB case notifications by site of disease, England, 2024

Type	Site of disease	Number of notifications	Percentage
Pulmonary	All pulmonary	2,983	54.3
Pulmonary	Miliary	167	3
Pulmonary	Laryngeal	19	0.3
Extra-pulmonary	All extra-pulmonary	3,455	62.9
Extra-pulmonary	Extra-thoracic lymph nodes	1,266	23.1
Extra-pulmonary	Intra-thoracic lymph nodes	868	15.8
Extra-pulmonary	Pleural	432	7.9
Extra-pulmonary	Other extra-pulmonary	970	17.7
Extra-pulmonary	Gastrointestinal	304	5.5
Extra-pulmonary	Bone – spine	245	4.5
Extra-pulmonary	Bone – not spine	104	1.9
Extra-pulmonary	Central nervous system (CNS) – meningitis	99	1.8
Extra-pulmonary	Genitourinary	87	1.6
Extra-pulmonary	Central nervous system (CNS) – other	46	0.8
Extra-pulmonary	Cryptic disseminated	60	1.1

Note to Table 3: individuals may have more than one site of disease. Pulmonary disease includes those with or without disease at another site in addition to the lungs.

Risk factors for pulmonary disease

When examining the risk ratios (RRs) of factors associated with pulmonary TB, the highest RRs were in people reporting at least one social risk factor (SRF) (1.4) followed by history of imprisonment (1.4) and males (1.2).

For people with at least one SRF, those born in the UK had a slightly lower RR (1.3 (CI:1.2 to 1.3)) of having pulmonary disease than people born outside the UK ((1.5 (CI:1.4 to 1.5)). A similar pattern is seen for people with a history of imprisonment (1.2 (CI: 1.1 to 1.3) in people born in the UK compared with 1.5 (CI:1.4 to 1.6) in people born outside the UK). In the 45 to 65 year old age group, people born in the UK were slightly more likely to have pulmonary disease than those born outside the UK (see Figure 8 and Supplementary Table 19).

Figure 8. Risk factors for pulmonary TB disease, England, 2022 to 2024 (aggregate data)

Notes to Figure 8:

• a risk ratio (or relative risk) compares the probability of an event (such as pulmonary TB) in one group compared to another, quantifying how much more or less likely the event is in one group versus another
• reference groups for the relative risks in the order they are presented are as followed: no social risk factors, female, no history of imprisonment, and aged 15 to 44 years old

Co-morbidities in TB

Comorbidities with other specific infections such as diabetes, HIV or chronic renal disease can increase susceptibility to TB by weakening immune defences. Some conditions can complicate TB diagnoses and require tailored treatment strategies. Additionally, comorbidities can often be linked to poorer outcomes including higher rates of treatment failure.

In 2024, 22.9% (1,259 out of 5,490) of people with TB were reported to have at least one comorbidity, which is similar to previous years. The highest reported comorbidity among TB notifications was diabetes (11.2%) followed by immunosuppression (7.1%), chronic renal disease (3,1%) and hepatitis B (2.2%) (see Table 4a and Supplementary Table 20).

Among those reporting immunosuppression (344 out of 5,490), 45.3% (156 out of 344) had other or not specified types of immunosuppression. A total of 26.2% (90 out of 344) reported cancer followed by 15.7% (54 out of 344) on biological therapies and 8.7% (30 out of 344) on steroids (see Table 4b).

Untreated HIV infection increases the risk of developing active TB disease and universal HIV testing is conducted within TB programmes. The proportion of people being offered HIV testing is recorded in NTBS although test results are not. Details of how HIV status is captured for analysis of HIV co-infection presented below can be seen in the Methodology and definitions chapter of this report.

Untreated HIV infection is well known to increase the risk of developing active TB disease. In 2024, 93.4% (5,125 out of 5,490) of individuals notified with unknown HIV status were recorded as being offered an HIV test.

In 2024, coinfection with HIV was recorded in 1.5% (83 out of 5,490) of individuals with TB compared to 3.6% (172 out of 4,831) in 2023. This is large reduction in coinfection rates compared to levels reported in previous years. This is primarily due to missing postcode data in surveillance data sets preventing matching of TB and HIV data and likely underestimates the number of coinfections . Further information is included in the Methodology and definitions chapter of this report.

The proportion of those with TB coinfected with HIV and hepatitis B or C also decreased to 0.13% (7 out of 5,490) in 2024 from 0.23% in 2023. HIV and hepatitis co-infection over time is available in Supplementary Table 20 of the accompanying data set.

Table 4a. Comorbidities in individuals with TB, England 2024

Co-morbidity	Number of people with TB	Proportion (percentage)	Total with data recorded
Diabetes	553	11.2	4,922
Chronic liver disease	64	1.3	4,832
Chronic renal disease	153	3.1	4,868
Hepatitis B	101	2.2	4,675
Hepatitis C	44	0.9	4,672
Immunosuppression	344	7.1	4,848

Table 4b. Causes of immunosuppression co-morbidity in people with TB, England, 2024

Reason for immunosuppression	Number of people with TB	Proportion (percentage)	Total with data recorded
Biological therapy	54	15.7	344
Transplantation	20	5.8	344
Cancer	90	26.2	344
Steroids	30	8.7	344
Other or not known immunosuppression	156	45.3	344

Cigarette smoking

Smoking is a well-known risk factor for TB, increasing both the risk of contracting TB as well as the severity of disease by impairing lung immune responses. In 2024, in those with smoking data available (86.2%, 4,732 out of 5,490), 22.0% (1,041 out of 4,732 ) reported a history of smoking, which is comparable to 23.2% (1,019 out of 4,384) reported in 2023 and higher than rates observed in the general population.

Social risk factors, deprivation and risk of TB

Social risk factors

Some groups of people are more likely to experience discrimination, social exclusion and stigma. This can often be due to factors such as homelessness, imprisonment, mental health needs or immigration status. These groups, which are commonly known as inclusion health groups, are well known to face substantial barriers to accessing healthcare, which can result in poorer health outcomes.

The national TB surveillance system collect data on 6 social characteristics, which are referred to in this report as social risk factors (SRFs). These are known to be associated with a higher risk of contracting TB and lead to people facing barriers in access to healthcare and poorer health outcomes.

NTBS collects data on:

1. Alcohol misuse
2. Drug misuse
3. Homelessness
4. Imprisonment
5. Mental health needs
6. Asylum seeker status

The aim of the following analysis is to examine social risk factors for TB notifications in people aged over 15 years old from 2018 onwards, which is when SRF data is most complete. In 2024, 5,354 notifications were included in the analysis (see Supplementary Table 21).

For further information on how SRF data is recorded, see the Methodology and definitions chapter of this report.

Proportions of people with TB and social risk factors

In 2024, in those over 15 years old, just over 1 in 7 notifications (15.3%, 815 out of 5,335) reported one or more SRF (see Table 5). This represents a slight decrease compared to 2023 (17.6 %) and a return to levels observed in 2019 (15.3 %). Two or more SRFs were reported in 6.7% (326 out of 4,861) of notifications in 2024, similar to 2023 (7.7%; 343 out of 4,457) (see Table 5 and Supplementary Table 21).

Current or previous homelessness remains the most common SRF in 2024 (6.3%, 298 out of 4,736) followed by current asylum seeker status (5.7%, 277 out of 4,834) and current or previous drug use (4.5%, 210 out of 4,706) (see Table 5 and Supplementary Table 21).

Table 5. Proportions of people aged 15 or more with individual social risk factors (SRFs), England 2024

Social risk factor	Number of people with TB	Total with data reported	Proportion (percentage)
Drug misuse (current or previous)	210	4,706	4.5
Alcohol misuse (current)	206	4,729	4.4
Homelessness (current or previous)	298	4,736	6.3
Prison (current or previous)	172	4,650	3.7
Asylum seeker (current)	277	4,834	5.7
Mental health needs (current)	146	4,645	3.1
One or more SRF	815	5,335	15.3
Two or more SRFs	326	4,861	6.7

Note to Table 5: the denominator for more than one SRF is the number of people with data recorded for at least 2 out of the 6 SRFs collected.

Examining SRFs by UKHSA region amongst TB notifications aged 15 year or older showed proportions of notifications with one or more SRF ranged from 13% (54 out of 409) in the East Midlands to 17.8% (111 out of 625) in the North West (see Supplementary Table 22).

Characteristics associated with having one or more social risk factors

People with TB reported as being unemployed were 2.7 times (RR 2.7, CI 2.3 to 3.1) more likely to report at least one SRF than people in employment. This was similar for people born in or outside of the UK (RR 2.9, CI 2.6 to 3.2). Males were 2.3 times more likely to report a SRF than females (RR 2.3, CI 1.9 to 2.7). The RR was higher in males born outside the UK (RR 3.4, CI 3.0 to 3.9).

The age group at which the RR of at least 1 SRF was highest varied by whether an individual was born in the UK or not. In people born in the UK, those aged between 45 to 64 years old were 1.4 times more likely to report a SRF compared to those aged 15 to 44 years old (RR 1.4, CI 1.2 to 1.6). However, in people born outside the UK, the RR was lower in the 45 to 64 years old group than in those the 15 to 44 years old (RR 0.8, CI 0.7 to 0.9). People aged over 65 had lower RR in both those born in and outside the UK (see Figure 8 and Supplementary Table 23).

Figure 9. Relative risks of factors associated with having one or more SRFs in people notified with TB between 2021 to 2024 (aggregate data), England, 2024

Notes to Figure 9:

• only those aged 15 years or older are included in Figure 9
• reference groups for risk ratios in the order presented are as follows: employed, female, and aged 15 to 44 years old

Data used to create figure can be found in Supplementary Table 23 of the accompanying data set.

Prevalence of social risk factors by place of birth, age and ethnicity

Analysis of SRFs in 2024 by age and place of birth show significant variation across factors. In people with TB born in the UK; 23.8% (1,345 out of 5,641) reported at least one SRF. Those aged 45 to 64 had the highest proportion with at least one SRF (29.0%, 84 out of 290) followed by 25 to 44 (28.9%, 83 out of 287) and over 65s (11.4%, 22 out of 193). The most common SRF amongst those born in the UK was drug misuse (13.1%) followed by alcohol misuse (7.9%) and prison history (7.0%) (see Supplementary Table 24).

The proportion reporting at least one SRF was lower in people born outside the UK at 13.8% (609 out of 4,418). The most common SRF was asylum seeker status (6.3%) followed by homelessness (5.3%) and alcohol misuse (3.0%) (see Supplementary Table 24).

Figure 10. Social risk factors by age and place of birth (UK-born or non-UK born), England, 2024

Data underlying this figure can be found in Supplementary Table 24 of the accompanying data set.

Analysis of SRFs by ethnicity and place of birth between 2019 and 2024 shows large variation in reported SRFs. In people born outside the UK, those of Sudanese ethnicity had the highest proportion reporting at least one SRF (56.3%) followed by those of Eritrean ethnicity (50.1%) and Afghan ethnicity (40.4%) (see Supplementary Table 25). Those of Pakistani ethnicity reported the lowest proportion (5.4%) followed by Indian (5.6%) and Bangladeshi (8.9%) (see Supplementary Table 25).

TB notification rate increased with increased levels of deprivation

Deprivation is a well-known contributing factor to TB risk, by increasing likelihood of overcrowded housing, poor nutrition and poorer access to healthcare and treatment. Data for 2024 continues to show those living in deprived areas have significantly higher rates of TB notifications. Those living in most deprived areas (Index of Multiple Deprivation or IMD score of 1) had a rate more than 5 times higher (17.5 per 100,000 population) than those in the least deprived areas (3.3 per 100,000; IMD score of 10). Inequalities have widened since 2019 when the rate in the most deprived areas was 4.4 times higher than in the least deprived (Figure 11).

Figure 11. TB notification rate by deprivation decile, England, 2019 to 2024

Note to Figure 11: the Index of Multiple Deprivation (IMD) ranks small areas in England by deprivation using 7 key domains including but not limited to income, housing, employment, crime and environment. Each area is scored and ranked nationally from most to least deprived.

Data used in this figure is available in Supplementary Table 26 of the accompanying data set.

Appendix

Figure A1a. Number (i) and rate (ii) of TB notifications in London, 2012 to 2024

Figure A1a (i)

Figure A1a (ii)

Figure A1b shows number (i) and rates (ii) of TB for East Midlands, Yorkshire and Humber, South West and North East UKHSA regions, 2012 to 2024.

Figure A1b (i)

Figure A1b (ii)

Figure A1c shows number (i) and notification rates (ii) of TB for West Midlands, South East, North West and East of England UKHSA regions 2012 to 2024.

Figure A1c (i)

Figure A1c (ii)

Data used in these figures is available in Supplementary Table 5 of the accompanying data set.

Figure A2a. Age and sex distributions by place of birth for UK-born people, 2024

Figure A2b. Age and sex distributions by place of birth for non-UK born people, 2024

Data used in this figure is available in Supplementary Table 10 of the accompanying data set.

Figure A3 shows number of TB notifications (a) and rates (b) by age groups and by place of birth (UK and non-UK born), England, 2024.

Figure A3 (a)

Figure A3 (b)

Data used in this figure is available in Supplementary Table 11 of the accompanying data set.

Figure A4a. Number of notifications by time since entry (years) to the UK for the 5 countries of birth with the highest number of notifications, 2019 to 2024 (scale varies)

Figure A4b. Number of notifications by time since entry (years) to the UK for by country of birth, 2019 to 2024

Notes to Figures A4a and A4b:

• countries shown in A4a are the 5 countries of birth with the highest number of notifications in 2023
• countries shown in A4b include those with more than 40 notifications in 2023 and are not included in the A4a of the 5 most frequent countries of birth in 2023
• where bars do not add up to 100%, this is due to missing data on year of entry to the UK

Data used in this figure is available in Supplementary Table 16 of the accompanying data set.

Figure A5. Rates of TB in UK and non-UK born by ethnic group, England, 2002 to 2024

Data used in this figure is available in Supplementary Table 18 of the accompanying data set.