Although other British cities exhibit a higher annual incidence of tuberculosis, no city's rates are currently rising faster than those of Liverpool (CDR Review 1995: 5; R29-R33). After reaching a low in 1987, notifications have gradually increased since. This study assesses the contribution of immigration to these rising tuberculosis rates. Ethnic origin was assigned by name to all notified cases of tuberculosis in Liverpool retrospectively from 1974 to the present. In addition, average tuberculosis rates were calculated for each of the thirty-three council wards in Liverpool for 1981-85 and 1991-95. Multiple regression was used to determine the independent effects of various socio-economic and population measures from the 1981 and 1991 censuses in explaining these ward-based rates. Since the mid 1970s, there has been a steady increase in the percentage of non-white cases of tuberculosis : from 8.7% in 1975-77, 151% in 1981-83, 17.5% in 1987-89 to 28.0% in 1993-95. The probable influence of immigration on tuberculosis in Liverpool was reinforced by the multiple regression analysis: in 1981 only unemployment showed a significant independent relationship with tuberculosis rates but in 1991 two indices of deprivation (overcrowding and elderly living alone) and ethnicity (proportion of households headed by a person born in the new commonwealth) significantly influenced tuberculosis rates. The increasing proportion of non-white tuberculosis cases in Liverpool over the last 20 years, despite a decline in total cases before 1987 and increasing rates since, is not consistent with idea that immigration has influenced the recent increase. However, the fact that ethnicity now independently explains some of the council ward variations in tuberculosis rates but did not in the early 1980s, suggests that immigration does influence the distribution of disease within the city. It is possible that immigrants are more likely to live in the poorer areas of Liverpool.

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