Tuberculosis and Homelessness in the United States, 1994-2003

Abstract

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.

Smear positive pulmonary tuberculosis and associated factors among homeless individuals in Dessie and Debre Birhan towns, Northeast Ethiopia

“…In contrast to studies conducted in USA [ 28 ], Rome [ 25 ] and Montreal, Canada [ 38 ], in this study alcohol drinking was not significantly associated with smear positive PTB. The reason might be more or less homeless individuals in this study, exhibit similar alcohol drinking characteristics (about three quarters of the participants were drunk alcohol during the study periods), this might reduce the individual variation and make it difficult to see its effect on outcomes of smear positive PTB.…”

“…Moreover, in this study, HIV infected homeless individuals were 6.75 times more likely to have smear positive PTB than those HIV uninfected homeless individuals. This is in line with studies conducted in USA [ 23 , 28 ] and Montreal, Canada [ 38 ]. It has well known that HIV infection often leads to a greater rate of TB either through reactivation or increased susceptibility to new infection with MTB thus, the main driving factor which aggravates TB.…”

Prevalence of pulmonary tuberculosis in homeless individuals in the Addis Ababa City, Ethiopia

“…In consistent with the observation of this study, previous studies conducted on homeless individuals in Colombia ( 45 , 46 ), Poland ( 47 ), USA ( 48 ), Rome ( 49 ) and South Korea ( 50 ) reported higher prevalence of TB in homeless individuals than in the general populations of their respective cities. Similarly, a systematic review and meta-analysis of the prevalence of TB in the homeless individuals recorded a range prevalence values that overlaps with the prevalence value recorded by the present study ( 51 , 52 ).…”

Alcohol use and clinical manifestations of tuberculosis

“…There have been numerous reports of tuberculosis outbreaks among the homeless population [22,23], likely due to increased risk of tuberculosis exposure, delays in tuberculosis diagnosis, and limited access to healthcare resources. Studies have shown a higher prevalence of drug and alcohol abuse in homeless tuberculosis cases compared with the non-homeless population with tuberculosis [8]. However, in our study the majority of excess alcohol users did not report homelessness or illicit drug use, indicating that an inability or unwillingness to access healthcare is not the sole explanation for our findings.…”