Objectisve-To examine factors responsible for the recent increase in tuberculosis in England and Wales.Design-Study of the incidence of tuberculosis (a) 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. IntroductionThe annual notification rate of tuberculosis in England and Wales has declined steadily for over a century. It levelled in the mid-1980s and increased by 12% between 1988 (5162 notifications) and 1992 (5798).' 2 The increase was more pronounced in younger age groups.2 This paper examines the causes

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