Social Course Patterns of Urban Dwellers with Tuberculosis under Fragile Living Conditions in Tokyo, Japan

BACKGROUND: People under fragile-living conditions show a high rate of interruption of tuberculosis treatment. We examined the social courses of fragile-living urban dwellers with tuberculosis without customary and regular access to a conventional residence and investigated the factors associated with interruption of treatment. METHODS: One hundred and nineteen tuberculosis patients without customary and regular access to a conventional residence who were discharged from a hospital with the largest number of tuberculosis beds in Tokyo between January 1998 and October 2000 were followed up. The associations between demographic, social, and clinical characteristics and interruption of treatment were examined. RESULTS: The subjects (mean age, 51.2 years) were followed up for a median of 342 days. The percentage of cases of interruption of treatment during inpatient care among patients with alcohol problems (56%) was significantly higher than that among patients without such problems (11%). The proportion of cases of interruption of treatment during outpatient care among patients who were literally homeless before admission (40%) was significantly higher than that in others (5%), and that among those who used transient hostels after the initial inpatient treatment (55%) was significantly higher than that in others (4%). The prevalence of drug resistance was higher in cases with than without a history of tuberculosis treatment (P<0.05). CONCLUSIONS: Factors associated with interruption of tuberculosis treatment in patients under fragile-living conditions were identified. Interruption during inpatient care was significantly associated with alcohol problems, and interruption during outpatient care was significantly associated with the use of transient hostels.