Tuberculosis infection and disease among persons seeking social services in New York City

Int J Tuberc Lung Dis. 1997 Feb;1(1):31-7.


Setting: A large public hospital in New York City.

Objective: To determine the prevalence of tuberculosis infection and disease in a cohort of indigent persons in New York.

Design: Persons seeking social services at any of five community-based organizations in New York City were screened for tuberculosis infection using tuberculin skin testing and a symptom questionnaire. Skin test or symptom positive persons were referred to the Bellevue Hospital Chest Clinic for a chest radiograph and medical evaluation. After this evaluation, patients were classified into a diagnostic category (e.g. tuberculosis infection, tuberculosis disease, no evidence of tuberculosis infection or disease).

Results: Of 651 persons screened, 591 (91%) completed the initial evaluation. The tuberculosis infection prevalence for the entire cohort was 41% (95% Confidence Interval [CI], 37% to 45%). Risk factors for infection included residence in a congregate setting, drug use, and birth outside the United States. Human immunodeficiency virus (HIV) infection was not a risk factor for infection. Eleven cases of active tuberculosis were also detected (disease prevalence of 1.7%, 95% CI, 0.85% to 3%). Most of the patients with active tuberculosis had documented HIV infection or clear risk factors for HIV.

Conclusion: We conclude that tuberculosis infection and disease remain common in populations characterized by poor housing conditions, drug use, and HIV infection. Linking a major medical provider with community-based organizations is an effective means to provide highly targeted screening services to a population at serious risk for disease acquisition and transmission.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Age Distribution
  • Cohort Studies
  • Community Health Services / statistics & numerical data*
  • Confidence Intervals
  • Female
  • Humans
  • Male
  • Mass Screening
  • Medical Indigency / statistics & numerical data*
  • Middle Aged
  • Multivariate Analysis
  • New York City / epidemiology
  • Prevalence
  • Risk Factors
  • Sex Distribution
  • Social Work / statistics & numerical data*
  • Tuberculosis / epidemiology*
  • Tuberculosis / prevention & control