Prevalence and Characteristics of Tuberculosis in the Korean Homeless Population Based on Nationwide Tuberculosis Screening

Han, Heesang; Lee, Ji-Hee; Chung, Sung Jun; Kim, Beong Ki; Kang, Yedham; Choi, Hangseok; Kim, Hee-Jin; Lee, Seung Heon

doi:.0..

Original Article

DOI: https://doi.org/10.4046/trd.2023.0197 [Accepted]
Published online May 3, 2024.

Prevalence and Characteristics of Tuberculosis in the Korean Homeless Population Based on Nationwide Tuberculosis Screening

Heesang Han, B.S.¹

, Ji-Hee Lee, M.D.²

, Sung Jun Chung, M.D., Ph.D.²

, Beong Ki Kim, M.D., Ph.D.²

, Yedham Kang, B.S.²

, Hangseok Choi, Ph.D.³

, Hee-Jin Kim, M.D., MPH⁴

, Seung Heon Lee, M.D., Ph.D.²

¹Korea University College of Medicine, Seoul, Korea
²Division of Pulmonary, Sleep, and Critical Care Medicine, Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Korea
³Medical Science Research Center, Korea University Ansan Hospital, Ansan, Korea
⁴Central Education Institution, Korean National Tuberculosis Association, Seoul, Korea

Correspondence: Seung Heon Lee, Tel: +82-31-412-4973, Fax: +82-31-412-5604,
Email: lee-sh@korea.ac.kr

Received: 27 December 2023 • Revised: 23 March 2024 • Accepted: 26 April 2024
*Heesang Han and Ji-Hee Lee contributed equally to this study as co-first authors.

Abstract

Background
The government of Korea implemented a strategy of prevention and early diagnosis in high-risk groups to reduce the tuberculosis (TB) burden. This study aims to investigate the TB epidemiology and gap in understanding of TB prevalence among homeless individuals by analyzing active TB chest X-ray (CXR) screening results in Korea.
Methods
The Korean National Tuberculosis Association conducted active TB screening with CXR for homeless groups from January 1 to December 31, 2021. Sputum acid fast bacilli smear and culture were performed for the subjects suggestive of TB on CXR. We performed a cross-sectional analysis of the data in comparison with the national health screening results from the general population.
Results
Among 17,713 homeless persons, 40 (0.23%), 3,077 (17.37%), and 79 (0.45%) were categorized as suggested TB, inactive TB, and observation required, respectively. Prevalence of suggested TB in the homeless was significantly higher (3–5 fold) than in the national general health screening based on age category (p < 0.005). Twenty-nine cases were confirmed as TB, yielding a prevalence of 164 cases per 100,000 individuals; 19 of these 29 cases showed inactive TB on CXR. Body mass index (p = 0.0478) and CXR result (p < 0.001) significantly correlated with confirmed TB based on multivariable analysis.
Conclusion
Nutrition status and CXR results, especially that of inactive TB, should be considered in active TB screening of the homeless population, where TB prevalence is higher than the general population.

Key Words: Homeless, Tuberculosis, Screening, Chest X-rays, Suggested TB

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ORCID iDs

Heesang Han
https://orcid.org/0000-0003-0750-5645

Ji-Hee Lee
https://orcid.org/0009-0006-3646-1951

Sung Jun Chung
https://orcid.org/0000-0001-8636-446X

Beong Ki Kim
https://orcid.org/0000-0003-2009-7658

Yedham Kang
https://orcid.org/0000-0002-8657-7315

Hangseok Choi
https://orcid.org/0000-0001-7412-8160

Hee-Jin Kim
https://orcid.org/0000-0002-0128-2789

Seung Heon Lee
https://orcid.org/0000-0002-7180-3877

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