One person a week dies with undiagnosed and untreated tuberculosis in England, according to a new study published in the journal Thorax. British-born older men are among those most likely to have the disease discovered only after death, suggesting healthcare workers may be overlooking TB in these patients.
Postmortem TB diagnoses should be 'never events'
Researchers described postmortem TB diagnosis as “the ultimate diagnostic delay” and called for it to be considered a “never event” that prompts urgent investigations. Dr Eleanor Morgan, co-author of the study and a resident doctor at Liverpool University Hospitals NHS Foundation Trust, 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.”
TB rates at a 10-year high
Tuberculosis rates in England have reached a 10-year high, with 9.4 cases per 100,000 people in 2024. This figure is just below the World Health Organization’s “low incidence country” threshold of 10 cases per 100,000, a level expected to be breached when 2025 figures are published. Most TB cases are diagnosed in people born outside the UK, with an average age of 36. However, postmortem diagnoses tend to occur in older, British-born individuals.
Risk factors for postmortem diagnosis
The study found that the likelihood of postmortem TB diagnosis was higher among people living outside London and those with a history of drug or alcohol misuse. Children under the age of four were also at increased risk, possibly due to underdeveloped immune systems, non-specific symptoms, and difficulties in obtaining samples for testing.
Global context and expert commentary
Tuberculosis is the world’s biggest infectious disease killer, causing 1.23 million deaths and an estimated 10.7 million illnesses in 2024. The disease is preventable and treatable with special antibiotics, and recent advances have shortened treatment duration even for drug-resistant forms. Dr Tom Wingfield of the Liverpool School of Tropical Medicine, the paper’s senior author, suggested that TB deaths should be investigated like superbug deaths in the NHS, using root cause analysis to prevent future fatalities. “TB is preventable, treatable and curable,” he said. “TB deaths should trigger learning, not blame.”
Impact of pandemic and aid cuts
Disruption to TB detection and treatment during the Covid-19 pandemic has led to a resurgence of the disease. Experts fear that aid cuts by the US and other donors may have a similar impact. Dr Paul Cleary, a consultant epidemiologist at the UK Health Security Agency and study co-author, noted that postmortem diagnoses “may represent missed opportunities to identify and treat the disease earlier, as well as to prevent possible transmission to others.”
