Study Reveals Weekly Undiagnosed Tuberculosis Deaths in England Amid Rising Cases

Research indicates that one person dies each week in England from tuberculosis (TB) that was undiagnosed and therefore untreated prior to death, highlighting critical gaps in early detection. British-born older men are disproportionately represented among these fatalities, suggesting that healthcare providers may be underestimating TB risks in this demographic.

Postmortem TB diagnoses, described as “the ultimate diagnostic delay,” should be classified as a “never event” requiring immediate systemic review, according to the study. With TB rates in England reaching 9.4 cases per 100,000 people in 2024—nearing the World Health Organization’s threshold for low-incidence countries—the findings underscore growing public health concerns.

While most TB cases are typically diagnosed in individuals born outside the UK and average 36 years in age, the study found postmortem cases involved older, British-born patients. Dr. Eleanor Morgan, co-author and NHS doctor, emphasized the need for clinicians to consider TB in patients outside traditional risk groups: “As TB rates rise, we must ask: ‘Could this be TB?’, even in people who don’t fit typical profiles.”

The research, published in Thorax, identified higher postmortem diagnosis rates among individuals outside London with histories of substance misuse. Children under four were also at elevated risk, likely due to underdeveloped immune systems, non-specific symptoms, and challenges in obtaining diagnostic samples.

TB remains the world’s deadliest infectious disease, with 1.23 million deaths and 10.7 million infections reported globally in 2024. Though preventable and treatable with antibiotics, delayed diagnoses lead to poorer outcomes, prolonged transmission, and missed opportunities for intervention. Dr. Tom Wingfield, senior author, proposed treating TB deaths as “never events” to trigger root cause analyses, mirroring protocols for investigating superbug-related fatalities.

The study’s limitations included uncertainty about whether patients died with TB as a contributing factor or from other causes. Dr. Paul Cleary, a UK Health Security Agency epidemiologist, noted that either scenario represents missed opportunities for earlier treatment and preventing transmission. Globally, disruptions to TB programs during the pandemic have led to resurgences, while fears mount over reduced funding from key donors like the US.

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