Nearly one person a week diagnosed with TB only after death, study finds

An average of almost one person a week in England was diagnosed with tuberculosis (TB) only after they had died between 2010 and 2022, according to a national study that highlights missed opportunities for earlier diagnosis and treatment.

The study, published in Thorax, analysed UK Health Security Agency (UKHSA) surveillance data covering 72,039 people diagnosed with TB over the 13-year period.

Researchers found that 574 people – 0.8% of all cases – were diagnosed only after death, equating to an average of almost one postmortem diagnosis each week.

The findings come as TB rates in England have reached a 10-year high, with 9.4 cases per 100,000 population recorded in 2024, while mortality among people diagnosed with TB is also at its highest level in a decade.

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The study’s researchers – from the Liverpool School of Tropical Medicine and the UKHSA – found that people diagnosed only after death were more likely to be older, male, UK-born, have a history of alcohol or drug misuse, and live outside London.

Although the majority of people diagnosed with TB in England are not UK-born, the authors said their findings suggest healthcare professionals may be less likely to suspect TB in older, UK-born patients who do not fit the traditional risk profile.

The likelihood of postmortem diagnosis increased from the age of 35 years onwards, although children aged under five were also found to be at elevated risk.

Dr Eleanor Morgan, resident doctor at Liverpool University Hospitals NHS Foundation Trust and co-author of the study, said: ‘As TB rates continue to rise, we need to keep asking, “could this be TB?” even in people who do not fit the usual risk profiles.

‘If England is to eliminate TB, reducing delays in diagnosis will be essential so that fewer people miss the opportunity to receive effective treatment.’

The researchers also found that the odds of postmortem diagnosis were significantly higher in every NHS region outside London, suggesting clinicians in lower-incidence areas could be less familiar with recognising the disease.

They said diagnosing TB only after death represented the ‘ultimate diagnostic delay’ and argued that such cases should be recognised as NHS ‘never events’, triggering formal root cause analysis to identify missed opportunities for earlier diagnosis.

The authors drew a comparison with the way serious healthcare-associated infections are handled.

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Senior author Dr Tom Wingfield, from the Liverpool School of Tropical Medicine, said: ‘Deaths related to superbugs like MRSA or C difficile are routinely investigated in the NHS and classified as never events.

‘Identifying TB as a never event that triggers root cause analysis could contribute to preventing future deaths.’

The authors also called for greater awareness of TB among healthcare professionals outside London, particularly when assessing older adults, young children and people with social risk factors such as alcohol or drug misuse.

Paul Cleary, consultant epidemiologist at the UKHSA, said: ‘People who have died with or from TB may represent missed opportunities to identify and treat the disease earlier, as well as to prevent possible transmission to others.

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‘This study improves our understanding of who may be most at risk of missed TB diagnosis and underlines the need for clinicians to remain alert to the possibility of TB in these groups, even as the disease becomes less common in England.’