Prevalence of tuberculosis, hepatitis C virus, and HIV in homeless people: a systematic review and meta-analysis
Summary Background 100 million people worldwide are homeless; rates of mortality and morbidity are high in this population. The contribution of infectious diseases to these adverse outcomes is uncertain. Accurate estimates of prevalence data are important for public policy and planning and developme...
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| Veröffentlicht in: | The Lancet infectious diseases 2012-11, Vol.12 (11), p.859-870 |
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| description | Summary Background 100 million people worldwide are homeless; rates of mortality and morbidity are high in this population. The contribution of infectious diseases to these adverse outcomes is uncertain. Accurate estimates of prevalence data are important for public policy and planning and development of clinical services tailored to homeless people. We aimed to establish the prevalence of tuberculosis, hepatitis C virus, and HIV in homeless people. Methods We searched PubMed, Embase, and Cumulative Index to Nursing and Allied Health Literature for studies of the prevalence of tuberculosis, hepatitis C virus, and HIV in homeless populations. We also searched bibliographic indices, scanned reference lists, and corresponded with authors. We explored potential sources of heterogeneity in the estimates by metaregression analysis and calculated prevalence ratios to compare prevalence estimates for homeless people with those for the general population. Findings We identified 43 eligible surveys with a total population of 63 812 (59 736 homeless individuals when duplication due to overlapping samples was accounted for). Prevalences ranged from 0·2% to 7·7% for tuberculosis, 3·9% to 36·2% for hepatitis C virus infection, and 0·3% to 21·1% for HIV infection. We noted substantial heterogeneity in prevalence estimates for tuberculosis, hepatitis C virus infection, and HIV infection (all Cochran's χ2 significant at p |
| doi_str_mv | 10.1016/S1473-3099(12)70177-9 |
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The contribution of infectious diseases to these adverse outcomes is uncertain. Accurate estimates of prevalence data are important for public policy and planning and development of clinical services tailored to homeless people. We aimed to establish the prevalence of tuberculosis, hepatitis C virus, and HIV in homeless people. Methods We searched PubMed, Embase, and Cumulative Index to Nursing and Allied Health Literature for studies of the prevalence of tuberculosis, hepatitis C virus, and HIV in homeless populations. We also searched bibliographic indices, scanned reference lists, and corresponded with authors. We explored potential sources of heterogeneity in the estimates by metaregression analysis and calculated prevalence ratios to compare prevalence estimates for homeless people with those for the general population. Findings We identified 43 eligible surveys with a total population of 63 812 (59 736 homeless individuals when duplication due to overlapping samples was accounted for). Prevalences ranged from 0·2% to 7·7% for tuberculosis, 3·9% to 36·2% for hepatitis C virus infection, and 0·3% to 21·1% for HIV infection. We noted substantial heterogeneity in prevalence estimates for tuberculosis, hepatitis C virus infection, and HIV infection (all Cochran's χ2 significant at p<0·0001; I2 =83%, 95% CI 76–89; 95%, 94–96; and 94%, 93–95; respectively). Prevalence ratios ranged from 34 to 452 for tuberculosis, 4 to 70 for hepatitis C virus infection, and 1 to 77 for HIV infection. Tuberculosis prevalence was higher in studies in which diagnosis was by chest radiography than in those which used other diagnostic methods and in countries with a higher general population prevalence than in those with a lower general prevalence. Prevalence of HIV infection was lower in newer studies than in older ones and was higher in the USA than in the rest of the world. Interpretation Heterogeneity in prevalence estimates for tuberculosis, hepatitis C virus, and HIV suggests the need for local surveys to inform development of health services for homeless people. The role of targeted and population-based measures in the reduction of risks of infectious diseases, premature mortality, and other adverse outcomes needs further examination. Guidelines for screening and treatment of infectious diseases in homeless people might need to be reviewed. Funding The Wellcome Trust.</description><identifier>ISSN: 1473-3099</identifier><identifier>EISSN: 1474-4457</identifier><identifier>DOI: 10.1016/S1473-3099(12)70177-9</identifier><identifier>PMID: 22914343</identifier><identifier>CODEN: LANCAO</identifier><language>eng</language><publisher>London: Elsevier Ltd</publisher><subject>Bacterial diseases ; Biological and medical sciences ; Data processing ; Hepatitis ; Hepatitis C - epidemiology ; Hepatitis C virus ; Heterogeneity ; HIV Infections - epidemiology ; Homeless Persons ; Homelessness ; Human bacterial diseases ; Human immunodeficiency virus ; Human viral diseases ; Humans ; Infectious Disease ; Infectious diseases ; Medical sciences ; Morbidity ; Mortality ; Mycobacterium ; Nursing ; Policy and planning ; Prevalence ; Public policy ; Radiography ; Reviews ; Tuberculosis ; Tuberculosis - epidemiology ; Tuberculosis and atypical mycobacterial infections ; Viral diseases ; Viral diseases of the lymphoid tissue and the blood. Aids ; Viral hepatitis</subject><ispartof>The Lancet infectious diseases, 2012-11, Vol.12 (11), p.859-870</ispartof><rights>Elsevier Ltd</rights><rights>2012 Elsevier Ltd</rights><rights>2015 INIST-CNRS</rights><rights>Copyright © 2012 Elsevier Ltd. All rights reserved.</rights><rights>2012 Elsevier Ltd. All rights reserved. 2012 Elsevier Ltd</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c703t-af46149b89fa11fe7de9ee3159dbbe64fcff3e53074c8ed9cd0d4977d41950923</citedby><cites>FETCH-LOGICAL-c703t-af46149b89fa11fe7de9ee3159dbbe64fcff3e53074c8ed9cd0d4977d41950923</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S1473309912701779$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>230,314,550,776,780,881,3537,27903,27904,65309</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=26545238$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22914343$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttp://kipublications.ki.se/Default.aspx?queryparsed=id:125611918$$DView record from Swedish Publication Index$$Hfree_for_read</backlink></links><search><creatorcontrib>Beijer, Ulla, PhD</creatorcontrib><creatorcontrib>Wolf, Achim, MSc</creatorcontrib><creatorcontrib>Fazel, Seena, Dr</creatorcontrib><title>Prevalence of tuberculosis, hepatitis C virus, and HIV in homeless people: a systematic review and meta-analysis</title><title>The Lancet infectious diseases</title><addtitle>Lancet Infect Dis</addtitle><description>Summary Background 100 million people worldwide are homeless; rates of mortality and morbidity are high in this population. The contribution of infectious diseases to these adverse outcomes is uncertain. Accurate estimates of prevalence data are important for public policy and planning and development of clinical services tailored to homeless people. We aimed to establish the prevalence of tuberculosis, hepatitis C virus, and HIV in homeless people. Methods We searched PubMed, Embase, and Cumulative Index to Nursing and Allied Health Literature for studies of the prevalence of tuberculosis, hepatitis C virus, and HIV in homeless populations. We also searched bibliographic indices, scanned reference lists, and corresponded with authors. We explored potential sources of heterogeneity in the estimates by metaregression analysis and calculated prevalence ratios to compare prevalence estimates for homeless people with those for the general population. Findings We identified 43 eligible surveys with a total population of 63 812 (59 736 homeless individuals when duplication due to overlapping samples was accounted for). Prevalences ranged from 0·2% to 7·7% for tuberculosis, 3·9% to 36·2% for hepatitis C virus infection, and 0·3% to 21·1% for HIV infection. We noted substantial heterogeneity in prevalence estimates for tuberculosis, hepatitis C virus infection, and HIV infection (all Cochran's χ2 significant at p<0·0001; I2 =83%, 95% CI 76–89; 95%, 94–96; and 94%, 93–95; respectively). Prevalence ratios ranged from 34 to 452 for tuberculosis, 4 to 70 for hepatitis C virus infection, and 1 to 77 for HIV infection. Tuberculosis prevalence was higher in studies in which diagnosis was by chest radiography than in those which used other diagnostic methods and in countries with a higher general population prevalence than in those with a lower general prevalence. Prevalence of HIV infection was lower in newer studies than in older ones and was higher in the USA than in the rest of the world. Interpretation Heterogeneity in prevalence estimates for tuberculosis, hepatitis C virus, and HIV suggests the need for local surveys to inform development of health services for homeless people. The role of targeted and population-based measures in the reduction of risks of infectious diseases, premature mortality, and other adverse outcomes needs further examination. Guidelines for screening and treatment of infectious diseases in homeless people might need to be reviewed. Funding The Wellcome Trust.</description><subject>Bacterial diseases</subject><subject>Biological and medical sciences</subject><subject>Data processing</subject><subject>Hepatitis</subject><subject>Hepatitis C - epidemiology</subject><subject>Hepatitis C virus</subject><subject>Heterogeneity</subject><subject>HIV Infections - epidemiology</subject><subject>Homeless Persons</subject><subject>Homelessness</subject><subject>Human bacterial diseases</subject><subject>Human immunodeficiency virus</subject><subject>Human viral diseases</subject><subject>Humans</subject><subject>Infectious Disease</subject><subject>Infectious diseases</subject><subject>Medical sciences</subject><subject>Morbidity</subject><subject>Mortality</subject><subject>Mycobacterium</subject><subject>Nursing</subject><subject>Policy and planning</subject><subject>Prevalence</subject><subject>Public policy</subject><subject>Radiography</subject><subject>Reviews</subject><subject>Tuberculosis</subject><subject>Tuberculosis - epidemiology</subject><subject>Tuberculosis and atypical mycobacterial infections</subject><subject>Viral diseases</subject><subject>Viral diseases of the lymphoid tissue and the blood. 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The contribution of infectious diseases to these adverse outcomes is uncertain. Accurate estimates of prevalence data are important for public policy and planning and development of clinical services tailored to homeless people. We aimed to establish the prevalence of tuberculosis, hepatitis C virus, and HIV in homeless people. Methods We searched PubMed, Embase, and Cumulative Index to Nursing and Allied Health Literature for studies of the prevalence of tuberculosis, hepatitis C virus, and HIV in homeless populations. We also searched bibliographic indices, scanned reference lists, and corresponded with authors. We explored potential sources of heterogeneity in the estimates by metaregression analysis and calculated prevalence ratios to compare prevalence estimates for homeless people with those for the general population. Findings We identified 43 eligible surveys with a total population of 63 812 (59 736 homeless individuals when duplication due to overlapping samples was accounted for). Prevalences ranged from 0·2% to 7·7% for tuberculosis, 3·9% to 36·2% for hepatitis C virus infection, and 0·3% to 21·1% for HIV infection. We noted substantial heterogeneity in prevalence estimates for tuberculosis, hepatitis C virus infection, and HIV infection (all Cochran's χ2 significant at p<0·0001; I2 =83%, 95% CI 76–89; 95%, 94–96; and 94%, 93–95; respectively). Prevalence ratios ranged from 34 to 452 for tuberculosis, 4 to 70 for hepatitis C virus infection, and 1 to 77 for HIV infection. Tuberculosis prevalence was higher in studies in which diagnosis was by chest radiography than in those which used other diagnostic methods and in countries with a higher general population prevalence than in those with a lower general prevalence. Prevalence of HIV infection was lower in newer studies than in older ones and was higher in the USA than in the rest of the world. Interpretation Heterogeneity in prevalence estimates for tuberculosis, hepatitis C virus, and HIV suggests the need for local surveys to inform development of health services for homeless people. The role of targeted and population-based measures in the reduction of risks of infectious diseases, premature mortality, and other adverse outcomes needs further examination. Guidelines for screening and treatment of infectious diseases in homeless people might need to be reviewed. Funding The Wellcome Trust.</abstract><cop>London</cop><pub>Elsevier Ltd</pub><pmid>22914343</pmid><doi>10.1016/S1473-3099(12)70177-9</doi><tpages>12</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Bacterial diseases Biological and medical sciences Data processing Hepatitis Hepatitis C - epidemiology Hepatitis C virus Heterogeneity HIV Infections - epidemiology Homeless Persons Homelessness Human bacterial diseases Human immunodeficiency virus Human viral diseases Humans Infectious Disease Infectious diseases Medical sciences Morbidity Mortality Mycobacterium Nursing Policy and planning Prevalence Public policy Radiography Reviews Tuberculosis Tuberculosis - epidemiology Tuberculosis and atypical mycobacterial infections Viral diseases Viral diseases of the lymphoid tissue and the blood. Aids Viral hepatitis |
| title | Prevalence of tuberculosis, hepatitis C virus, and HIV in homeless people: a systematic review and meta-analysis |
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