Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
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Prevalence and Characteristics of Tuberculosis in the Korean Homeless Population Based on Nationwide Tuberculosis Screening

  • Heesang Han (Korea University College of Medicine) ;
  • Ji-Hee Lee (Division of Pulmonary, Sleep and Critical Care Medicine, Department of Internal Medicine, Korea University Ansan Hospital) ;
  • Sung Jun Chung (Division of Pulmonary, Sleep and Critical Care Medicine, Department of Internal Medicine, Korea University Ansan Hospital) ;
  • Beong Ki Kim (Division of Pulmonary, Sleep and Critical Care Medicine, Department of Internal Medicine, Korea University Ansan Hospital) ;
  • Yedham Kang (Division of Pulmonary, Sleep and Critical Care Medicine, Department of Internal Medicine, Korea University Ansan Hospital) ;
  • Hangseok Choi (Medical Science Research Center, Korea University Ansan Hospital) ;
  • Hee-Jin Kim (Central Education Institution, Korean National Tuberculosis Association) ;
  • Seung Heon Lee (Division of Pulmonary, Sleep and Critical Care Medicine, Department of Internal Medicine, Korea University Ansan Hospital)
  • Received : 2023.12.27
  • Accepted : 2024.04.26
  • Published : 2024.10.31
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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.

Keywords

Acknowledgement

We thank the Korean National Tuberculosis Association for consignment research (2021-KNTA-27) and the Korea Disease Control and Prevention Agency for organization of the projects (TB prevention and supportive projects of 2021 National Health Promotion Fund), as well as Korea University Medical College for participation of the students and 2022 student research grant.

References

  1. Min J, Kim HW, Kim JS. Tuberculosis: Republic of Korea, 2021. Tuberc Respir Dis (Seoul) 2023;86:67-9.
  2. Korea Disease Control Prevention Agency. 2022 National tuberculosis management guideline. Cheongju: Korea Disease Control Prevention Agency; 2021.
  3. Murray CJ, Lopez AD. Global mortality, disability, and the contribution of risk factors: Global Burden of Disease Study. Lancet 1997;349:1436-42.
  4. World Health Organization. Systematic screening for active tuberculosis: principles and recommendations [Internet]. Geneva: WHO; 2013 [cited 2024 May 15]. Available from: https://apps.who.int/iris/handle/10665/84971.
  5. Lim DY, Lee TJ, Ha ES, Lee BJ, Nam YJ, Nam KC, et al. 2021 Homeless survey [Internet]. Sejong: Korea Institute for Health and Social Affairs; 2021 [cited 2024 May 15]. Available from: https://www.mohw.go.kr/board.es?mid=a10411010100&bid=0019.
  6. World Health Organization. Implementing the end TB strategy: the essentials. Geneva: WHO; 2015.
  7. Choi YA. Directly observed treatment in homeless people. Seoul: Seoul Dasiseogi Support Center; 2013.
  8. Park S, Sung C, Choi H, Lee YW, Kang Y, Kim HJ, et al. Comparison of active tuberculosis case finding strategies for immigrants in South Korea: epidemiology and cost-effectiveness analysis. PLoS One 2023;18:e0283414.
  9. Nishtar T, Burki S, Ahmad FS, Ahmad T. Diagnostic accuracy of computer aided reading of chest X-ray in screening for pulmonary tuberculosis in comparison with Gene- Xpert. Pak J Med Sci 2022;38:62-8.
  10. Oh IH, Lee SH. Investigation for tuberculosis screening and management policy to decrease the burden of tuberculosis based on health care big data. Cheongju: Korea Health Industry Development Institute; 2023.
  11. Kim J, Lee H, In H, Kim Y. Characteristics of the notified tuberculosis: the Republic of Korea, 2021. Public Health Wkly Rep 2022;15:729-46.
  12. Korea Disease Control and Prevention Agency. 11-1790387-000332-10: Annual report on the notified tuberculosis in Korea, 2022 [Internet]. Cheongju: Korea Disease Control and Prevention Agency; 2022 [cited 2024 May 15]. Available from: https://www.kdca.go.kr/board/board.es?mid=a31001000000&bid=0130.
  13. Lonnroth K, Williams BG, Cegielski P, Dye C. A consistent log-linear relationship between tuberculosis incidence and body mass index. Int J Epidemiol 2010;39:149-55.
  14. Sharma N, Basu S, Chopra KK. Achieving TB elimination in India: the role of latent TB management. Indian J Tuberc 2019;66:30-3.
  15. Kim HS, Shin DW, Lee WC, Kim YT, Cho B. National screening program for transitional ages in Korea: a new screening for strengthening primary prevention and follow- up care. J Korean Med Sci 2012;27 Suppl:S70-5.
  16. Choi YR, Yoon SH, Kim J, Yoo JY, Kim H, Jin KN. Chest radiography of tuberculosis: determination of activity using deep learning algorithm. Tuberc Respir Dis (Seoul) 2023;86:226-33.
  17. Heo DJ, Min HG, Lee HH. The clinical characteristics and predictors of treatment success of pulmonary tuberculosis in homeless persons at a public hospital in Busan. Korean J Fam Med 2012;33:372-80.
  18. Kim Y, Lee JY, Jeong I, Kim J, Kim J, Han J, et al. Factors related to successful tuberculosis treatment in vulnerable groups. Korean J Med 2022;97:50-9.
  19. Nam KC. A study on homeless monitoring in Korea. Health Soc Welf Rev 2011;31:158-93.
  20. Chong SW, Park JI. Legal tasks to promote human rights of undocumented migrants. J Legis Res 2016;51:409-49.
  21. Burman WJ, Cohn DL, Rietmeijer CA, Judson FN, Sbarbaro JA, Reves RR. Noncompliance with directly observed therapy for tuberculosis: epidemiology and effect on the outcome of treatment. Chest 1997;111:1168-73.