title: Counting the homeless: a previously incalculable tuberculosis risk and its social determinants.
abstract: Tuberculosis (TB) surveillance among the homeless is not supported by the political will necessary for TB elimination. We merged the first stakeholder-accepted enumeration of homeless persons with existing surveillance data to assess TB risk among the homeless in Houston, Texas. The average incidence per 100,000 was 411 among homeless and 9.5 among housed persons. The homeless were more likely than the housed to be US-born, clustered, and in a larger-sized cluster. Multivariate analysis revealed that TB rates among the homeless were driven not by comorbidities but by social determinants. Homeless patients were hospitalized more days than the housed and required more follow-up time. Reporting of TB rates for populations with known health disparities could help reframe TB prevention and better target limited funds.
authors.affiliation: Division of Epidemiology Human Genetics and Environmental Science, School of Public Health, University of Texas, Houston, TX, USA. epitx@me.com
authors.forename: Marsha L
authors.initials: ML
authors.lastname: Feske
authors.forename: Larry D
authors.initials: LD
authors.lastname: Teeter
authors.forename: James M
authors.initials: JM
authors.lastname: Musser
authors.forename: Edward A
authors.initials: EA
authors.lastname: Graviss
mesh_terms: D000293:Adolescent; D000328:Adult; D015897:Comorbidity; D005260:Female; D015658:HIV Infections / Q000453:epidemiology; D054624:Health Status Disparities; D006703:Ill-Housed Persons / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011159:Population Surveillance / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors; D019966:Substance-Related Disorders / Q000453:epidemiology; D011795:Surveys and Questionnaires; D013781:Texas / Q000453:epidemiology; D014376:Tuberculosis / Q000191:economics / Q000453:epidemiology* / Q000517:prevention & control; D055815:Young Adult