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TB in the Homeless Population


A disproportionate number of TB cases occur among high-risk populations, including people experiencing homelessness.

In the United States, 1% of the population experiences homelessness in a given year, but more than 5% of people with TB reported being homeless within the year prior to diagnosis. These findings are not surprising, as people experiencing homelessness have a high occurrence of conditions that increase the risk of TB, including substance abuse, HIV infection, and congregation in crowded shelters. This combination of conditions is favorable for spreading TB. In addition, people who are homeless often lack ready access to the medical care required to make an early diagnosis of TB.

TB Cases by Homeless Status, Age ≥ 15, United States, 1993-2011. This graph shows the number of TB cases reported to be homeless within twelve months prior to their TB diagnosis from 1993 through 2011. Cases must have been above 14 years of age. The number of homeless cases has decreased from a high of 1379 cases in 1994 to 565 in 2011 and parallels the overall decline in cases during this time. This category has seen a continuous decrease in cases since 1994; the years 2003, 2006, and 2010 have been exceptions with a small increase in cases. Of total cases, 6.8% were homeless in 1994 and percentages have ranged between 7.5% in 1993 and 5.4% in 2009. Since 2009 there has been a small increase in 2010 (5.7%) and in 2011 (5.8%).


What CDC is Doing

To address TB among the homeless population, CDC is 

  • Collaborating with other national and public health organizations to improve screening, diagnosis, and treatment for people experiencing homelessness.
  • Working to improve TB control activities in partnership with healthcare agencies addressing the needs of people experiencing homelessness.

In the fall of 2015, CDC hosted a “Workshop on Tuberculosis (TB) and Homelessness: Infection-Control Measures in Homeless Shelters and Other Overnight Facilities that Provide Shelter.”  The workshop brought together homeless service providers, TB controllers, and public health department staff to engage in strategic planning around improving TB control among persons experiencing homelessness and prevent new TB incidence among those utilizing and providing services (i.e., clients, staff and volunteers).

The homeless population represents an important risk group among U.S.-born TB patients. To achieve TB elimination, ongoing efforts are needed to address the disproportionate number of TB cases among this high-risk population.

CDC Resources on the Homeless Population

Additional Resources

For Patients - Basic TB Information

TB Facts Series

Questions and Answers about Tuberculosis

For additional CDC resources on TB, see Patient and General Public Materials.

For Health Care Providers