Background: A disproportionate amount of tuberculosis (TB) cases and mortality occur among people experiencing homelessness in the United States (US). Our objective was to identify risk factors for mortality among reported homeless TB cases in Texas, a state with an increased TB prevalence in the US.
Methods: Using data from the Centers for Disease Control and Prevention TB Genotyping Information Management System (TB GIMS), we evaluated the demographic, laboratory and clinical characteristics of people identified as being homeless in the year preceding TB diagnosis in Texas from 01/01/2010 12/31/2017. TB cases with missing or unknown homeless status were removed from the analysis. Multivariate logistic regression was used to analyze and evaluate risk factors associated with homeless status and mortality among homeless TB cases.
Results: Of the 10,103 newly diagnosed TB cases over the 8 year period, 543 (5.4%) were reported as being homeless in the year preceding TB diagnosis. In 412 homeless TB patients with a reported outcome as died or completed, 57 (13.8%) died during treatment and 355 (86.2%) completed therapy. Age >45, male, black ethnicity, foreign-born, urban living, excessive alcohol consumption, IDU, long-term care facility resident, diabetes, previous TB, and pulmonary TB were associated with homeless TB cases. Being homeless and having TB increased the risk of mortality compared to having TB alone (OR 2.26, p<0.01). Age > 45 years, positive HIV status, cavitary and miliary radiographic findings, no or unknown culture conversion and TB case confirmation by a positive culture/NAA/smear compared to clinical case definition/provider diagnosis were independent risk factors for mortality among homeless TB cases in Texas.
Conclusion: Being homeless increased the risk of TB mortality by nearly 130% compared to being housed prior to TB diagnosis. Our findings indicate that homelessness may be being diagnosed and treated in more advanced TB diseased homeless individuals who probably have poorer health due to the stresses of poverty, comorbidities, and lack of access to health care, leading to higher mortality. Additionally, testing and treatment for HIV among those reporting homelessness may reduce mortality among this high risk group.
E. A. Graviss, None