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Tuberculosis and Homelessness in the United States, 1994-2003
CONTEXT Tuberculosis (TB) rates among US homeless persons cannot be calculated because they are not included in the US Census. However, homelessness is often associated with TB. OBJECTIVES To describe homeless persons with TB and to compare risk factors and disease characteristics between homeless a...
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Published in: | JAMA : the journal of the American Medical Association 2005-06, Vol.293 (22), p.2762-2766 |
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Main Authors: | , , , , |
Format: | Article |
Language: | English |
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Summary: | CONTEXT Tuberculosis (TB) rates among US homeless persons cannot be calculated
because they are not included in the US Census. However, homelessness is often
associated with TB. OBJECTIVES To describe homeless persons with TB and to compare risk factors and
disease characteristics between homeless and nonhomeless persons with TB. DESIGN AND SETTING Cross-sectional analysis of all verified TB cases reported into the
National TB Surveillance System from the 50 states and the District of Columbia
from 1994 through 2003. MAIN OUTCOME MEASURES Number and proportion of TB cases associated with homelessness, demographic
characteristics, risk factors, disease characteristics, treatment, and outcomes. RESULTS Of 185 870 cases of TB disease reported between 1994 and 2003,
11 369 were among persons classified as homeless during the 12 months
before diagnosis. The annual proportion of cases associated with homelessness
was stable (6.1%-6.7%). Regional differences occurred with a higher proportion
of TB cases associated with homelessness in western and some southern states.
Most homeless persons with TB were male (87%) and aged 30 to 59 years. Black
individuals represented the highest proportion of TB cases among the homeless
and nonhomeless. The proportion of homeless persons with TB who were born
outside the United States (18%) was lower than that for nonhomeless persons
with TB (44%). At the time of TB diagnosis, 9% of homeless persons were incarcerated,
usually in a local jail; 3% of nonhomeless persons with TB were incarcerated.
Compared with nonhomeless persons, homeless persons with TB had a higher prevalence
of substance use (54% alcohol abuse, 29.5% noninjected drug use, and 14% injected
drug use), and 34% of those tested had coinfection with human immunodeficiency
virus. Compared with nonhomeless persons, TB disease in homeless persons was
more likely to be infectious but not more likely to be drug resistant. Health
departments managed 81% of TB cases in homeless persons. Directly observed
therapy, used for 86% of homeless patients, was associated with timely completion
of therapy. A similar proportion in both groups (9%) died from any cause during
therapy. CONCLUSIONS Individual TB risk factors often overlap with risk factors for homelessness,
and the social contexts in which TB occurs are often complex and important
to consider in planning TB treatment. Nevertheless, given good case management,
homeless persons with TB can achieve excellent treatment outcom |
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ISSN: | 0098-7484 1538-3598 |
DOI: | 10.1001/jama.293.22.2762 |