Counting the homeless: A previously incalculable tuberculosis risk and its social determinants

Marsha L. Feske, Larry D. Teeter, James M. Musser, Edward A. Graviss

Research output: Contribution to journalArticlepeer-review

20 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)839-848
Number of pages10
JournalAmerican Journal of Public Health
Issue number5
StatePublished - May 2013

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health


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