Background In New York City, the incidence of tuberculosis hasmore than doubled during the past decade. We examined the incidenceof tuberculosis and the acquired immunodeficiency syndrome (AIDS)and the rate of death from all causes in a very-high-risk group— indigent subjects who abuse drugs, alcohol, or both.
Methods In 1984 we began to study prospectively a cohort ofwelfare applicants and recipients 18 to 64 years of age whoabused drugs or alcohol. The incidence rates of tuberculosis,AIDS, and death for this group were ascertained through vitalrecords and New York City's tuberculosis and AIDS registries.
Results The cohort was followed for eight years. Of the 858subjects, tuberculosis developed in 47 (5.5 percent), 84 (9.8percent) were given a diagnosis of AIDS, and 183 (21.3 percent)died. The rates of incidence per 100,000 person-years were 744for tuberculosis, 1323 for AIDS, and 2842 for death. In thisgroup of welfare clients, the rate of newly diagnosed tuberculosiswas 14.8 times that of the age-matched general population ofNew York City; the rate of AIDS was 10.0 times as high; andthe death rate was 5.2 times as high. There was no significantdifference in the rate of new cases of tuberculosis betweensubjects with positive skin tests and those with negative skintests at examination in 1984.
Conclusions Among indigent alcohol and drug abusers in New YorkCity, the rates of tuberculosis, AIDS, and death are extremelyhigh. In this population, a single positive or negative skintest does not predict the development of tuberculosis, probablybecause both anergy and new infections are common. If programsto control tuberculosis and AIDS are to be effective in groupsof indigent substance abusers, health services must be integratedinto the welfare delivery system.
Source Information
From the Pulmonary and Critical Care Section, Yale University School of Medicine, New Haven, Conn., and the Departments of Intensive Care and Quality Management, Milford Hospital, Milford, Conn. (L.N.F.); the Bureau of Tuberculosis Control (M.T.W., T.R.F.) and the Office of AIDS Surveillance (T.P.S.), New York City Department of Health, New York; and the Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta (T.R.F.).
Address reprint requests to Dr. Friedman at the Departments of Intensive Care and Quality Management, Milford Hospital, 2047 Bridgeport Ave., Milford, CT 06460.
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