TUBERCULOSIS, AIDS, AND DEATH AMONG SUBSTANCE-ABUSERS ON WELFARE IN NEW-YORK-CITY

Background. In New York City, the incidence of tuberculosis has more t han doubled during the past decade. We examined the incidence of tuber culosis and the acquired immunodeficiency syndrome (AIDS) and the rate of death from all causes in a very-high-risk group - indigent subject s who abuse drugs, alcohol, or both. Methods. In 1984 we began to stud y prospectively a cohort of welfare applicants and recipients 18 to 64 years of age who abused drugs or alcohol. The incidence rates of tube rculosis, AIDS, and death for this group were ascertained through vita l records and New York City's tuberculosis and AIDS registries. Result s. The cohort was followed for eight years. Of the 858 subjects, tuber culosis developed in 47 (5.5 percent), 84 (9.8 percent) were given a d iagnosis of AIDS, and 183 (21.3 percent) died. The rates of incidence per 100,000 person-years were 744 for tuberculosis, 1323 for AIDS, and 2842 for death. In this group of welfare clients, the rate of newly d iagnosed tuberculosis was 14.8 times that of the age-matched general p opulation of New York City; the rate of AIDS was 10.0 times as high; a nd the death rate was 5.2 times as high. There was no significant diff erence in the rate of new cases of tuberculosis between subjects with positive skin tests and those with negative skin tests at examination in 1984. Conclusions. Among indigent alcohol and drug abusers in New Y ork City, the rates of tuberculosis, AIDS, and death are extremely hig h. In this population, a single positive or negative skin test does no t predict the development of tuberculosis, probably because both anerg y and new infections are common. If programs to control tuberculosis a nd AIDS are to be effective in groups of indigent substance abusers, h ealth services must be integrated into the welfare delivery system. (C ) 1996, Massachusetts Medical Society.