Prevalence of tuberculosis, hepatitis C virus, and HIV in homeless people: a systematic review and meta-analysis.
Prevalence of tuberculosis, hepatitis C virus, and HIV in homeless people: a systematic review and meta-analysis.
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DOI：
10.1016/s1473-3099(12)70177-9
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发表时间：
2012-11
影响因子：
56.3
通讯作者：
Fazel, Seena
中科院分区：
文献类型：
--
作者：
Beijer, Ulla;Wolf, Achim;Fazel, Seena
全世界有1亿人无家可归；这一人群的死亡率和发病率都很高。传染病对这些不良后果的影响尚不确定。对流行率数据的准确估计对于公共政策以及为无家可归者量身定做的临床服务的规划和发展非常重要。我们的目标是确定结核病、丙型肝炎病毒和艾滋病毒在无家可归者中的流行率。我们检索了PubMed、Embase和Cumulative Index to Nursing and Related Health文献，以研究结核病、丙型肝炎病毒和艾滋病毒在无家可归人群中的流行情况。我们还搜索了书目索引，扫描了参考文献列表，并与作者通信。我们通过元回归分析探索了估计中潜在的异质性来源，并计算了患病率，以比较无家可归者和普通人群的患病率估计值。我们确定了43项符合条件的调查，总人数为63 812(如果考虑重叠样本造成的重复，则为59 736名无家可归者)。结核病患病率为0.2%~7.7%，丙型肝炎病毒感染率为3.9%~36.2%，HIV感染率为0.3%~21.1%。我们注意到结核病、丙型肝炎病毒感染和艾滋病毒感染的患病率估计有很大的异质性(所有Cochran‘sχ2分别在P<；0.0001；I2=83%，95%CI 76-；95%，94-96；94%，93-95；P<；0.0001；I2=83%，95%CI 76-；95%，93-95)。结核病的患病率从34到452，丙型肝炎病毒感染的患病率从4到70，艾滋病毒感染的患病率从1到77。在通过胸片诊断的研究中，结核病患病率高于使用其他诊断方法的研究，在总体人口流行率高于总体流行率的国家中也是如此。在新的研究中，艾滋病毒感染率低于旧研究，而在美国高于世界其他地区。结核病、丙型肝炎病毒和艾滋病毒流行率估计的异质性表明，需要进行地方调查，为无家可归者提供卫生服务的发展提供信息。有针对性和以人口为基础的措施在减少传染病、过早死亡和其他不良后果风险方面的作用需要进一步审查。无家可归者的传染病筛查和治疗指南可能需要审查。威康信托基金。
100 million people worldwide are homeless; rates of mortality and morbidity are high in this population. The contribution of infectious diseases to these adverse outcomes is uncertain. Accurate estimates of prevalence data are important for public policy and planning and development of clinical services tailored to homeless people. We aimed to establish the prevalence of tuberculosis, hepatitis C virus, and HIV in homeless people. We searched PubMed, Embase, and Cumulative Index to Nursing and Allied Health Literature for studies of the prevalence of tuberculosis, hepatitis C virus, and HIV in homeless populations. We also searched bibliographic indices, scanned reference lists, and corresponded with authors. We explored potential sources of heterogeneity in the estimates by metaregression analysis and calculated prevalence ratios to compare prevalence estimates for homeless people with those for the general population. We identified 43 eligible surveys with a total population of 63 812 (59 736 homeless individuals when duplication due to overlapping samples was accounted for). Prevalences ranged from 0·2% to 7·7% for tuberculosis, 3·9% to 36·2% for hepatitis C virus infection, and 0·3% to 21·1% for HIV infection. We noted substantial heterogeneity in prevalence estimates for tuberculosis, hepatitis C virus infection, and HIV infection (all Cochran's χ2 significant at p<0·0001; I2=83%, 95% CI 76–89; 95%, 94–96; and 94%, 93–95; respectively). Prevalence ratios ranged from 34 to 452 for tuberculosis, 4 to 70 for hepatitis C virus infection, and 1 to 77 for HIV infection. Tuberculosis prevalence was higher in studies in which diagnosis was by chest radiography than in those which used other diagnostic methods and in countries with a higher general population prevalence than in those with a lower general prevalence. Prevalence of HIV infection was lower in newer studies than in older ones and was higher in the USA than in the rest of the world. Heterogeneity in prevalence estimates for tuberculosis, hepatitis C virus, and HIV suggests the need for local surveys to inform development of health services for homeless people. The role of targeted and population-based measures in the reduction of risks of infectious diseases, premature mortality, and other adverse outcomes needs further examination. Guidelines for screening and treatment of infectious diseases in homeless people might need to be reviewed. The Wellcome Trust.