TB deaths in homeless not improving: study

About 20 per cent of homeless people with tuberculosis die within a year of diagnosis, a new Toronto study finds.

About 20 per cent of homeless people with tuberculosis die within a year of diagnosis, a new Toronto study finds.

The 10-year study published in Wednesday's issue of the journal Emerging Infectious Diseases also found some key recommendations made by a provincial coroner's inquest in 2001 have not been implemented.

"Ten years ago we had a lot of problems with TB in our shelters with roughly about 20 per cent of patients dying [within] one year of diagnosis," said Dr. Michael Gardam, medical director of the tuberculosis clinic at Toronto Western Hospital and one of the study's authors.

A decade later, that figure hasn't changed, the researchers found.

The inquest into the death of Joseph Teigesser, a homeless man who died of tuberculosis in Toronto in 2001, made 13 formal recommendations. These included provincial funding for a centralized clinic system to provide specialized care for people with TB and improvements to shelter ventilation — two recommendations that have fallen short, the study's authors said.

Despite several reports on how to fight the treatable, airborne disease, timing is often a problem, said Dr. Elizabeth Rea, a study co-author and associate medical officer of health with Toronto Public Health.

"If someone is diagnosed relatively early with TB, even if they're homeless,even if they have a slew of other problems we can get them safely through treatment. But there are still a lot of people who are diagnosed late," said Rea.

Inadequate housing, substance dependence, language barriers, mental health problems and stigma complicate TB treatment, the researchers noted.

The team also found tuberculosis among homeless persons born outside of Canada is on the rise — nearly 40 per cent of  homeless tuberculosis cases were in immigrants.

That change in patients increases the risk of introducing a drug-resistant strain of TB into the shelter system, Gardam said. If so, it could set off an outbreak that could possibly spread to the general population, he added.

Worldwide, TB claimed the lives of 1.7 million people in 2009, according to the World Health Organization.