Todd W. Wilson, MS, CHES, Maryam B. Haddad, MSN, MPH, FNP, Kashef Ijaz, MD, and Marisa Moore, MD, MPH. National Center for HIV, STD, and TB Prevention, Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop E-10, Atlanta, GA 30333, 404-639-5303, twilson@cdc.gov

To describe TB trends among the U.S. homeless, we analyzed data for cases reported to the national TB surveillance system during 1994–2002. Of 171,025 TB cases reported, 163,888 (96%) had information on homeless status; of these, 10,434 (6%) were in persons homeless in the year before diagnosis. Although the proportion of TB cases occurring among the homeless remained stable, the annual number decreased 37% (from 1,392 in 1994 to 880 in 2002). Of all TB cases in homeless persons, the proportion from the Northeast declined from 24% in 1994 to 11% in 2002, and the proportion from the South increased, from 30% to 42%. Most homeless cases (91%) occurred in persons aged 25–64, but the age distribution shifted. The proportion among those aged 25–44 decreased from 57% in 1994 to 42% in 2002 and, among those aged 45–64, increased from 34% to 48%. During 1994–2002, the majority of cases occurred in blacks (45%), whites (30%), and Hispanics (19%), and 83% were U.S.-born. A high proportion had used excess alcohol (60%), noninjecting drugs (35%), and injecting drugs (16%) in the year prior to diagnosis, and 23% were coinfected with HIV. The 1994–2002 decline in TB cases among homeless persons paralleled the overall decline in U.S. cases and likely resulted from successful measures to interrupt TB transmission. TB control and prevention strategies for this high-risk population should consider the increasing proportions from the South and in 45- to 64-year-olds, and the high prevalence of substance abuse.

Learning Objectives:

• Describe the trends in tuberculosis (TB) among the homeless population in the United States from 1994-2002.
• Recognize that the substantial overall decline in TB among the homeless in the United States likely resulted from successful measures to interrupt TB transmission.
• Discuss the implications of changing demographics and the role of concurrent substance abuse for this high-risk, difficult-to-reach population.

Keywords: TB, Homelessness

Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: Centers for Disease Control and Prevention, national tuberculosis surveillance system, Atlanta, GA. No commercial products discussed.
I have a significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.
Relationship: Employee of CDC, NCHSTP, Division of TB Elimination