Canada - one in five homeless people with tuberculosis died within a year of their diagnosis

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The death rate from tuberculosis in homeless people in Toronto is “alarmingly high”, an infectious disease expert warns.

A 10-year study looking into the homeless in Toronto found that one in five homeless people with tuberculosis died within a year of their diagnosis.

“Homeless people diagnosed with tuberculosis in Toronto have an alarmingly high mortality rate of 20%. That’s three to four times higher than someone would expect to see in the normal population,” said lead author Dr. Kamran Khan, an infectious disease physician and scientist at St. Michael’s Hospital.

Khan says Toronto’s homeless shelters have been lucky because a drug resistant strain of TB has not entered the shelter system. But, Khan warned if a multi-drug resistant TB strain did, it could set off an outbreak that would become very difficult to control.

Khan said it’s imperative to set up ventilation systems within the shelter system to manage the potential for the disease to spread.

Khan says more work needs to be done to provide appropriate care to people infected by the disease.

One of the recommendations which resulted from an inquest where a homeless man died of TB, was to develop a centralized clinic system. Today, several health care providers care for people diagnosed with TB, but these health care providers have limited exposure with TB.

Khan said the second major finding of the study is the face of the tuberculosis population is changing and has become more diverse with 40% being immigrants. He says this raises the risk that dangerous drug resistant strains of tuberculosis could enter the shelter system.

Khan said the treatment of tuberculosis is often complicated by inadequate housing, substance dependence, language barriers, mental health problems, and the enormous stigma that comes with the disease.

The study is published in the Emerging Infectious Diseases journal.