Lancet Infect Dis： 流浪者患传染病几率远高于普通人

很多地方都有无家可归的流浪人员，英国的一项新研究显示，流浪者患传染病的几率远高于普通人群，如果医卫部门能为这些人提供传染病检查服务，将有助提高整个社会的健康水平。

英国牛津大学等机构的研究人员在英国新一期医学刊物《柳叶刀传染病》（<em>The Lancet Infectious Diseases</em>）上报告说，他们综合分析了过去几十项研究中约6万名流浪人员的资料，发现他们患传染病的几率远高于普通人群。

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在英国，流浪人员患结核病的几率比普通人高34倍，患丙肝的几率高50倍。在美国，流浪人员患结核病的几率比普通人高46倍。此外他们患艾滋病等其他传染病的几率也相对更高。

参与这项研究的塞纳·法策尔说，流浪人员患传染病几率更高的主要原因是他们长期颠沛流离、生存环境不好、营养不良导致免疫力下降等。

法策尔说，流浪人员所患的传染病可能通过各种途径传染其他人，因此医卫部门应考虑为这一群体提供传染病检查等医疗服务，这将有助于提高整个社会的健康水平，减少公众患传染病的风险。

据估计，美国有超过65万名流浪人员，英国约有10万名流浪者。 
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<a title="" href="http://dx.doi.org/10.1016/S1473-3099(12)70177-9" target="_blank">doi:10.1016/S1473-3099(12)70177-9</a>
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<br/><strong>Prevalence of tuberculosis, hepatitis C virus, and HIV in homeless people: a systematic review and meta-analysis</strong><br/>


Ulla Beijer, Achim Wolf, Seena Fazel

Background

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.

Methods

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.

Findings

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&lt;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.

Interpretation

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.

<br/>来源：新华社

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