LA County Department of Public Health - Tuberculosis Control Program

Los Angeles County Department of Health Services
Public Health Programs and Services
Tuberculosis Control Program
1996 Homeless Fact Sheet
Tuberculosis Epidemiology Update

The most recent and comprehensive studies conservatively estimate that within the course of one year there are up to 236,400 homeless people in Los Angeles County. Single adults constitute 75% of this homeless population, parents and children constitute 20%, and unaccompanied youth account for the other 5%.¹
Of the 1,375 tuberculosis cases confirmed in Los Angeles County in 1996, 127 (9%) were homeless. In 1995, 154 (9%) of 1,622 TB cases were reported as homeless.
Of the 127 homeless TB cases in 1996, 118 (93%) were male and 9 (7%) were female.
Most (35%) of the homeless TB cases were between the ages of 35 and 44 years old (45 cases). Another 30% were between the ages of 45 and 54 years old (38 cases). No pediatric TB cases confirmed in 1996 were reported as homeless.
In 1996, 50% of all homeless TB cases were black, 33% were Hispanic, and 17% were white. No Asian TB cases were reported as homeless.
Most (69%) of the homeless TB cases were born in the United States (87 cases).
Central Health District, which includes the areas of downtown Los Angeles and skid row, reported the largest number of homeless TB cases (70 cases, 55%), followed by Hollywood Health District (9 cases, 7%) and Inglewood Health District (7 cases, 6%).
In 1996, over 80% of all homeless TB cases initially started anti-tuberculosis treatment on directly observed therapy (DOT). This represents an increase from the previous year when 61% of homeless TB cases initially started treatment on DOT.
Since 1987, extrapulmonary TB has been an AIDS-defining condition; in 1993, the AIDS case definition was expanded to include pulmonary TB as well. In 1996, 85% of all homeless TB cases were tested for HIV infection (108 cases). Of the 127 homeless TB cases, 22 (17%) were coinfected with HIV. This represents a 37% decrease in the proportion of HIV-positive homeless TB cases from 1995 (41 cases, 27%).
Studies of homeless patients with TB in Los Angeles County suggest that much of the TB disease in this population is due to recent infection and not to reactivation of old infection as once believed. Clusters of alike DNA fingerprints from the cultures of homeless TB cases have been linked to common locations concurrently frequented by these patients.²

¹ The Number of Homeless People in Los Angeles City and County July 1993 to June 1994; Shelter Partnership, Inc.; November 1995.

². Barnes PF, El-Hajj H, Preston-Martin S, et al; Transmission of tuberculosis among the urban homeless; JAMA; 1996; 275; 305-7.