Comparison of TB features in homeless persons and in
non-homeless patients.
TB cases reported to National TB Register in Poland in whom
information about the social status was available (the data about the social
status were collected obligatorily in the years 2004-2013 only) were analysed.
The results of DSTs were obtained from laboratory records and were available
for the cases reported since 2010. Treatment outcome after 12 months was
analysed for the cases registered between 2004-2012. The significance (Si) of
the differences in proportions was assessed with chi-square test. P< 0.05
was regarded as statistically significant. Test F was used to evaluate the
significance of differences of the means of age. The multivariate logistic
regression models were applied to find out the independently operating
determinants of not achieving of success of treatment.
2,349 homeless persons (HP) and 72,989 other patients (OP)
with TB were included. In the group of HP, there was a greater proportion of
males in comparison with OP (90.5% vs. 66.3%) (Si). The mean age of HP was 49.8
years (SD ± 10.9); of OP - 52.9 years (SD ± 17.5) (Si). 16.6% of HP and 10.4%
of OP were previously treated for TB (Si). The previous treatment was adequate
in 62.2% of HP and in 85.8% of OP (Si). Pulmonary TB was in 98.0%,
extrapulmonary TB in 2.0% of HP and, respectively, in 92.5% and 7.5% of OP
(Si). Pulmonary TB was confirmed by culture in 76.3% of HP and in 64.5% of OP
(Si). Sputum smears were positive in 70.7% of HP and in 62.5% of OP (Si).
Caseous pneumonia occurred in 2.7% of homeless subjects and in 1.1% of OP (Si);
infiltrative TB in 95.5% of HP and in 97.5% of OP (Si). Resistance to isoniazid
was observed in 2.9% of HP and in 3.1% of OP; to rifampicin in 0.0% of HP and
in 0.2% of OP; to isoniazid and rifampicin in 0.4% of HP and in 0.8% of OP.
These differences were not Si. Treatment success rate among HP was 44.1%;
default rate 24.8%; 4.0% of HP died from tuberculosis; 3.2% died from other
causes; 5.2% were transferred and their outcomes were unknown; 0.4% were still
on treatment; 0.4% had treatment failure; in 17.9% of HP results of treatment
were not available. Among other TB patients the rate of success was 66.8%; of
default - 8.8%; 1.9% died from TB; 3.1% died from other causes; 2.6% were
transferred; 0.5% were still treated; 0.2% had treatment failure; in 16.1% the
results were not reported. Differences between both groups were Si, except for
the category "died from other causes", "still on treatment"
and "treatment failure".
In the group of homeless persons with tuberculosis phenomena
which indicate a delay in diagnosis of disease and in some cases the
possibility of a recent infection and also unfavorable treatment outcomes occur
in a greater proportion than among other patients. Targeted screening for TB
and directly observed treatment could likely improve the epidemiological
situation of tuberculosis in the population of homeless.
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By:
- 1National Tuberculosis and Lung Diseases Research Institute, Department of Tuberculosis Epidemiology and Surveillance.
- 2National Tuberculosis and Lung Diseases Research Institute, I Department of Lung Diseases.
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