Hospitalization of homeless persons with tuberculosis in the United States

doi:10.2105/ajph.90.3.435

Cited by 35 publications

(9 citation statements)

References 11 publications

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“…This has implications for resource planning, given increasing drug-resistant TB globally. There was also evidence for an increased hospitalization rate and longer LOS of homeless patients in our study, similar to previous studies [14, 25]. …”

Section: Discussionsupporting

confidence: 93%

“…These data can be used by planners to better capture TB resource implications especially with regard to the cost effectiveness of treatment of LTBI. Our finding that homeless patients were more likely to be admitted with longer LOS, suggests a need for earlier diagnosis and treatment for these patients, and is supported by similar findings by Marks et al in the US [25]. Our finding that Canadian-born patients tended to have more severe disease at the time of diagnosis suggests a need for interventions to reduce diagnostic delay, such as increased training for health care professionals, patients, and community members to increase their TB awareness.…”

Section: Discussionsupporting

confidence: 88%

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Predictors of hospitalization of tuberculosis patients in Montreal, Canada: a retrospective cohort study

et al. 2016

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BackgroundHospitalization is the most costly health system component of tuberculosis (TB) control programs. Our objectives were to identify how frequently patients are hospitalized, and the factors associated with hospitalizations and length-of-stay (LOS) of TB patients in a large Canadian city.MethodsWe extracted data from the Montreal TB Resource database, a retrospective cohort of all active TB cases reported to the Montreal Public Health Department between January 1996 and May 2007. Data included patient demographics, clinical characteristics, and dates of treatment and hospitalization. Predictors of hospitalization and LOS were estimated using logistic regression and Cox proportional hazards regression, respectively.ResultsThere were 1852 active TB patients. Of these, 51% were hospitalized initially during the period of diagnosis and/or treatment initiation (median LOS 17.5 days), and 9.0% hospitalized later during treatment (median LOS 13 days). In adjusted models, patients were more likely to be hospitalized initially if they were children, had co-morbidities, smear-positive symptomatic pulmonary TB, cavitary or miliary TB, and multi- or poly-TB drug resistance. Factors predictive of longer initial LOS included having HIV, renal disease, symptomatic pulmonary smear-positive TB, multi- or poly-TB drug resistance, and being in a teaching hospital.ConclusionsWe found a high hospitalization rate during diagnosis and treatment of patients with TB. Diagnostic delay due to low index of suspicion may result in patients presenting with more severe disease at the time of diagnosis. Earlier identification and treatment, through interventions to increase TB awareness and more targeted prevention programs, might reduce costly TB-related hospital use.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 88%

Predictors of hospitalization of tuberculosis patients in Montreal, Canada: a retrospective cohort study

et al. 2016

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“…These animal models all reflect acute infection, or what in humans is termed “primary TB disease” or “progressive primary disease.” This occurs most commonly in children <5 years of age ( 25 ) or in HIV infected persons ( 26 ). However, in one large study of 20,687 household contacts (HHCs) age 5 years or older), 598 (4.9%) had primary TB ( 25 ).…”

Section: Inhaled Dose–response In Animal Models Of Tbmentioning

confidence: 99%

Quantity and Quality of Inhaled Dose Predicts Immunopathology in Tuberculosis

Fennelly

Jones-López

2015

Front. Immunol.

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Experimental animal models of tuberculosis (TB) have convincingly demonstrated that inhaled dose predicts immunopathology and survival. In contrast, the importance of inhaled dose has generally not been appreciated in TB epidemiology, clinical science, or the practice of TB control. Infectiousness of TB patients has traditionally been assessed using microscopy for acid-fast bacilli in the sputum, which should be considered only a risk factor. We have recently demonstrated that cough aerosol cultures from index cases with pulmonary TB are the best predictors of new infection among household contacts. We suggest that cough aerosols of M. tuberculosis are the best surrogates of inhaled dose, and we hypothesize that the quantity of cough aerosols is associated with TB infection versus disease. Although several factors affect the quality of infectious aerosols, we propose that the particle size distribution of cough aerosols is an important predictor of primary upper airway disease and cervical lymphadenitis and of immune responses in exposed hosts. We hypothesize that large droplet aerosols (>5 μ) containing M. tuberculosis deposit in the upper airway and can induce immune responses without establishing infection. We suggest that this may partially explain the large proportion of humans who never develop TB disease in spite of having immunological evidence of M. tuberculosis infection (e.g., positive tuberculin skin test or interferon gamma release assay). If these hypotheses are proven true, they would alter the current paradigm of latent TB infection and reactivation, further demonstrating the need for better biomarkers or methods of assessing TB infection and the risk of developing disease.

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“…These factors, as well as cultural and language barriers among foreign-born patients ( 28 , 29 ), may contribute to delays in seeking health care, which lead to advanced disease and hospitalization ( 27 , 30 , 31 ). For our sample, hospitalization rates were high; >80% of patients were hospitalized.…”

Section: Discussionmentioning

confidence: 99%

Active Tuberculosis among Homeless Persons, Toronto, Ontario, Canada, 1998–2007

Khan

Rea²,

McDermaid³

et al. 2011

Emerg. Infect. Dis.

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While tuberculosis (TB) in Canadian cities is increasingly affecting foreign-born persons, homeless persons remain at high risk. To assess trends in TB, we studied all homeless persons in Toronto who had a diagnosis of active TB during 1998–2007. We compared Canada-born and foreign-born homeless persons and assessed changes over time. We identified 91 homeless persons with active TB; they typically had highly contagious, advanced disease, and 19% died within 12 months of diagnosis. The proportion of homeless persons who were foreign-born increased from 24% in 1998–2002 to 39% in 2003–2007. Among foreign-born homeless persons with TB, 56% of infections were caused by strains not known to circulate among homeless persons in Toronto. Only 2% of infections were resistant to first-line TB medications. The rise in foreign-born homeless persons with TB strains likely acquired overseas suggests that the risk for drug-resistant strains entering the homeless shelter system may be escalating.

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Hospitalization of homeless persons with tuberculosis in the United States

Cited by 35 publications

References 11 publications

Predictors of hospitalization of tuberculosis patients in Montreal, Canada: a retrospective cohort study

Predictors of hospitalization of tuberculosis patients in Montreal, Canada: a retrospective cohort study

Quantity and Quality of Inhaled Dose Predicts Immunopathology in Tuberculosis

Active Tuberculosis among Homeless Persons, Toronto, Ontario, Canada, 1998–2007

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