This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (16)  • Contact me when this article is cited  Related Content  • Related article  • Similar articles in JAMA  Topic Collections  • Tuberculosis/ Other Mycobacterium  • Pulmonary Diseases  • Pulmonary Diseases, Other  • Infectious Diseases  • Alert me on articles by topic  Social Bookmarking   What's this?

Maryam B. Haddad, MSN, MPH, FNP; Todd W. Wilson, MS, CHES; Kashef Ijaz, MD, MPH; Suzanne M. Marks, MPH, MA; Marisa Moore, MD, MPH

JAMA. 2005;293:2762-2766.

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 outcomes.

Author Affiliations: Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, Ga.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati     What's this?

RELATED ARTICLE

Tuberculosis, Vulnerability, and Access to Quality Care
Philip C. Hopewell and Madhukar Pai
JAMA. 2005;293(22):2790-2793.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Drug abuse profile - patient delay, diagnosis delay and drug resistance pattern - among addict patients with tuberculosis
Shamaei et al.
Int J STD AIDS 2009;20:320-323.
ABSTRACT | FULL TEXT  

Tuberculosis and Substance Abuse in the United States, 1997-2006
Oeltmann et al.
Arch Intern Med 2009;169:189-197.
ABSTRACT | FULL TEXT  

Prevalence of Tuberculosis Infection in the United States Population: The National Health and Nutrition Examination Survey, 1999-2000
Bennett et al.
Am. J. Respir. Crit. Care Med. 2008;177:348-355.
ABSTRACT | FULL TEXT  

Tuberculosis in London: the importance of homelessness, problem drug use and prison
Story et al.
Thorax 2007;62:667-671.
ABSTRACT | FULL TEXT  

Impact of Mobile Radiographic Screening on Tuberculosis among Drug Users and Homeless Persons
de Vries et al.
Am. J. Respir. Crit. Care Med. 2007;176:201-207.
ABSTRACT | FULL TEXT  

The impact of physician training and experience on the survival of patients with active tuberculosis.
Khan et al.
CMAJ 2006;175:749-753.
ABSTRACT | FULL TEXT  

TB and Homelessness
JWatch Emergency Med. 2005;2005:8-8.
FULL TEXT  

What's new in the other general journals
Martyn
BMJ 2005;330:1411-1412.
FULL TEXT  

Tuberculosis, Vulnerability, and Access to Quality Care
Hopewell and Pai
JAMA 2005;293:2790-2793.
FULL TEXT  

Tuberculosis--A Global Problem Requiring a Global Solution
DeAngelis and Flanagin
JAMA 2005;293:2793-2794.
FULL TEXT