名古屋学芸大学健康･栄養研究所年報

第２号

２００８年

《Original Article》

Comparison between homeless and non-homeless people at Nagoya about
the prevalence of active and inactive pulmonary tuberculosis according
to chest x-ray findings
Katsumi Yamanaka＊ and Toshio Takatorige＊＊

Summary
1, The prevalence of active and inactive pulmonary tuberculosis (TB) in the homeless people in a shelter during
winter (1996-1999) in Nagoya was 28-57 % in 50-59, 60-69 and 70-79 age groups. The prevalence of activepulmonary TB in the homeless people was 9.8 %.
2, The prevalence of active and inactive pulmonary TB in non homeless males was around 30 % in Nakamura
ward in 40-49, 50-59, 60-69, and 70-79 age groups, and 30 % in Tenpaku ward in 70-79 age group in 1996.
The incidence of registered TB patients was higher in Nakamura ward than in Tenpaku ward. The incidencein Nakamura ward was two times higher than in Tenpaku ward.
3, The prevalence of active and inactive pulmonary TB in non-homeless females in 70-79 age group was 26% in Nakamura ward and 17 % in Tenpaku ward in 1996.
4, TB lesions on the lung manifested in only 30 % of cases shown on a chest x-ray examination, even if all
people were infected by TB bacillus.
5, We can estimate the degree of TB infiltration in the groups by analyzing the prevalence of active and inactive
TB lesions on a chest x-ray film.
Key words: prevalence of pulmonary tuberculosis, homeless, chest x-ray finding

Conversely, a chest x-ray examination is often

Introductionused to know whether an individual have an active

In general, in order to know if a person was in-TB lesion or not in their lung. Besides active TB

fected with tuberculosis (TB) a tuberculin reaction

lesions, there are many TB lesions which show atest is used. In the field of public health, this test isTB infection from the past. By analyzing these TB

often used to discover the prevalent infectious ratelesions on the chest x-ray film, we may estimateof people in different groups. However, it is often

the degree of TB infiltration in different groups.

not possible to know of a TB infection by using theWe would like to report the possibility of such antuberculin test because of the influence of a BCG

estimate.

vaccination.

＊ Nagoya University of Arts and Sciences, School of Nutritional Sciences＊＊ Osaka University Graduate School of Medicine, Department of Social and Environmental Medicine, Public Health1selected as subjects to analyze after removing 118

Methods

people who took the examination twice or more in

1, Cases

1995-1999, and one female. The number (the preva-1) The people who had a chest x-ray examination

lence) of active and inactive cases of TB was 156

over the Christmas and New Year period in 1995-1999(35.0 %).
The higher the age group was, the higher theat a shelter for homeless people in Nagoya.

prevalence of TB was. However the rate in the age2) The people who had a chest x-ray examinationgroup 70-79 years decreased as shown in Table 1.

in 1996 as part of a general screening program for

Diagnostic standard of TB was adopted theresidents (i.e. non-homeless) in Nakamura-ward ofroentgenological classification of pulmonary TB.

Nagoya[the Gakkai classification (GC)]. The active cases

Nakamura-ward was the area where the incidence(GC: I, II, III, IV) were 43 which was 27.6 % out ofand prevalence of registered TB patients were the156 TB cases as shown in Table 1. The prevalence

highest out of the 16 wards in Nagoya.

of active TB cases was 9.4 % in 453 persons. The
healed cases (GC: V including pleurisy and pleural3) The people who had a chest x-ray examinationadhesion) was 113 which was 73.4 % out of 156 TBin 1996 as part of a general screening program forcases. The percentage of pleurisy or pleural adhesion

residents (i.e.non-homeless) in Tenpaku-ward ofcases was 30 % of the inactive cases.

Nagoya.
2, non-homeless people in Nakamura-ward

Tenpaku-ward was the area where the incidence

The number of people who had a chest x-ray

and prevalence of registered TB patients were theexamination in accordance with the TB control law

lowest out of the 16 wards in Nagoya city.

was 1,354 males (111 in 30-39 age group, 155 in
40-49 age group, 261 in 50-59 age group, 110 in

2, Chest x-ray examination
A mobile mass fluoro-radiography (indirect radi-60-69 age group and 274 in 70-79 age group) andography) was used for the examination. The condi-

3,304 females (240 in 30-39 age group, 608 in 40-49

tion of radiographic-imaging was that the x-ray wasage group, 977 in 50-59 age group, 1126 in 60-69

radiated from posterior to anterior, and there was aage group, and 353 in 70-79 age group) in 1996 in

distance of 100 cm distance from x-ray tube to theNakamura ward. The number of cases with activefilm.

or inactive TB was 246 (18.2 %) for males and 338(10.2 %) for females. The prevalence of active andinactive pulmonary TB cases according to gender3, Diagnosis
Two doctors, authors with extensive experience inand to the age group was shown in Table 2 and 3.

diagnosing TB patients using chest x-ray films, readThe prevalence of TB cases increased according

the homeless people’s film, and one doctor, one of

to age for both genders. Around 30 % in the preva-authors read the non homeless people’s film.

lence of TB was recognized in males of 60-69 and70-79 age groups, and around 25 % in females in
70-79 age group.

Result3, non-homeless people in Tenpaku-ward

1, homeless people at a shelterThe number of the people who had the chest x-The number of people who had a chest x-ray

ray examination was 97 in1995,118 in 1997, 100

examination in accordance with the TB control

in 1998 and 152 in 1999. Finally, 454 males werelaw was 753 males (100 in 30-39 age group, 1222

Comparison between homeless and non-homeless people about the prevalence of active and inactive pulmonary tuberculosis

Table 1. Cases of tuberculosis (TB) according to chest x-ray film of thehomeless people by Gakken classification
AgegroupTB

ActiveTotal
examinecases%20-3931

   4

12.9

40-49

111

2550-59

19460-69

IIIII

IVV1   3

23.4

342

1667

34.5

48748

110

58

57.6

410447   2

28.0453

156

100.0

1620

70-79

IInactive   27113

Gakken classification
I : Active tuberculosis with large cavity
II : Active tuberculosis with other cavity except I
III : Active tuberculosis without cavity
IV : Stationary tuberculosis
V : Inactive tuberculosis (adhesion of calcification)

Table 2. Prevalence (%) of active and inactive pulmonary tuberculosis (TB) of homeless males, nonhomeless males in Nakamura and Tenpaku ward
diagnosed by chest x-ray film
Agegroup

Table 3. Prevalence (%) of active and inactive pulmonary
tuberculosis (TB) of non-homeless females inNakamura ward and Tenpaku ward diagnosed bychest x-ray film

Prevalence (%) of active and inactive TB
Homeless

NakamuraTenpaku

n=453

n=1354n=753

Agegroup

Prevalence (%) of active and inactive TB
Nakamura ward

Tenpaku ward

N=3304

N=2708

30-39

12.9

1.8

2.0

30-39

2.1

1.7

40-49

23.4

2.6

7.4

40-49

3.6

3.050-59

34.5

10.3

6.4

50-59

6.7

6.2

60-69

57.6

30.0

21.8

60-69

13.6

9.6

70-79

28.0

31.4

29.5

70-79

26.3

16.9

34.8

18.2

15.7

10.2

6.2

in 40-49 age group, 116 in 50-59 age group, 2934, Comparison between homeless males, non-in 60-69 age group and 122 in 70-79 age group)

homeless males in Nakamura and Tenpaku

and 2,708 females (408 in 30-39 age group, 643 in

There was a 10-20 % difference in active and in-40-49 age group, 825 in 50-59 age group, 684 in

active TB prevalence between the homeless males

60-69 age group and 148 in 70-79 age group) inand the non-homeless males in 30-39 and 40-49

1996 in Tenpaku ward. The number of cases withage groups as shown in Table 2. TB prevalence

active or inactive TB was 118 (15.7 %) for males

in homeless males was 3-7 times higher than TB

and 168 (16.9 %) for females. The prevalence ofprevalence in non-homeless males in 30-39 andactive and inactive pulmonary TB cases according to40-49 age groups. Over 60 years old, TB prevalence

gender and to age groups are shown in Table 2 and 3.

for homeless males became about equal to that for

The prevalence of TB cases increased according to

non-homeless males, because TB prevalence of non-aging in both gender. Around 30 % in the prevalencehomeless males had increased.

of TB was recognized in 70-79 age group of males
only, and around 17 % was recognized in 70-79 age

5, Comparison between non-homeless people ingroup of females.

Nakamura and Tenpaku ward
In males, the pulmonary TB prevalence was3

higher in Nakamura ward than in Tenpaku ward.

of pulmonary TB for females was 24-29 % in 40-49,

These differences were recognized in males in 50-59

50-59, 60-69 and 70-79 age groups in 1953 and 1968

and 60-69 age groups. The prevalence was 4-8 %as shown in Table 4 and 5. Decreasing was not rec-higher in Nakamura ward than in Tenpaku ward.

ognized in females

For females, there was no difference in pulmo­

Otherwise, the prevalence of active and inac-nary TB prevalence in 30-39, 40-49 and 50-59 age

tive pulmonary TB cases in homeless people wasgroups, however, the pulmonary TB prevalence inaround 30 % in the 40-49, 50-59, 60-69 and 70-79

Nakamura ward was 5 % in 60-69 age group, andage groups in 1995-1999. The prevalence of TB in

10 % in 70-79 age group, higher than in Tenpaku

homeless people at present was similar to the Japa-ward.

nese males in 1953-1967 in 40 years ago.
The prevalence (9.8 %) of active TB in homelesspeople in this study was slightly higher than thatDiscussionof the homeless in other studies: 1.9-3.2 % in Nare-kamura ward of Nagoya 3), 1.9-2.5 % in Nagoya ofported that the prevalence of active and inactive TB

those registered as homeless4), 3.0-6.9 % in Nagoya5),cases in 30-39, 40-49, 50-59, 60-69 and 70-79 age

6.0 % in Osaka6), 5.2-7.9 % in Osaka7), 6 % in thegroups was around 30 % for males. The same Sur-USA8,9) and 0.9 % in England10), and 1.5 % in Lon-vey in 1967 2) reported that the prevalence of active

don11). The prevalence of active and inactive TB inand inactive TB cases was around 30 % for males

chest-x-ray examinations for the homeless people

in 40-49, 50-59, 60-69 and 70-79 age groups. The

was reported to be 26.8 % and 30 % in Osaka6,7). The

prevalence of active and inactive TB decreased only

prevalence of active and inactive TB in this study

in the male 30-39 age group from 1953 to 1967.

was equal to or slightly higher than these values

Decreasing of prevalence was 15 %. The prevalence(26.8 % nad 30 %).

The Japanese TB Prevalence Survey 1953

1)

Table 4. Prevalence (%) of active and inactive pulmonary tuberculosis (TB)
of Japanese males in 1953 and 1968 diagnosed by chest x-rayfilmAge
group

1953

1968

active and inactive active

active and inactive active

30-39

28.5(13.0)

14.4( 2.9)

40-49

29.2(13.4)

28.8( 7.1)

50-59

30.4(12.8)

32.7( 8.9)

60-69

32.8

(14.6)

33.3( 9.6)

70-79

34.9

(15.2)

34.3(10.0)

Table 5. Prevalence of active and inactive pulmonary tuberculosis (TB) of
Japanese females in 1953 and 1968 diagnosed by chest x-ray film
Age
group

1953

1968

active and inactive active

active and inactive active

30-39

13.0

(7.6)

13.1

(2.1)

40-49

23.6

(7.8)

20.5(3.2)

50-59

25.4

(6.9)

24.2

(3.2)

60-69

27.2

(7.0)

26.9

(3.8)

70-79

28.9

(9.0)

23.9(3.7)

4

Comparison between homeless and non-homeless people about the prevalence of active and inactive pulmonary tuberculosis

city from 1991 to 1995. Kekkaku (1998) 73, 387-394,

The incidence (per 100.000) of registered active5)

TB patients in Nakamura ward was 82.7 in 1995,

Kobayashi F, Watanabe T: A study on the health andliving condition of day-labourers: analysis of 5 years

and 77.5 in 1996, and the prevalence in Tenpaku

of health examination records. Nippon Koshu Eisei

ward was 27.7 in 1995 and 34.8 in 1996.

Zasshi (1986) 33, 761-768

The incidence of registered active TB patients in6)

Yamaguchi I, Kitahara H, Nakai T: Today’s tubercu-Nakamura ward was twice as high than it was inlosis condition and its problem in the future in Airin,Tenpaku ward. Nakamura ward can be defined as theOsaka. Kekkaku (1986) 61, 135-136 (The English title

high incidence district and Tenpaku ward defined as

was translated from the Japanese title by the author)
7)

the low incidence district in Nagoya.

Takatorige T, Ohsaka T, Yamamoto S et al: Tuberculosis and its control measures for homeless people:

The chest x-ray examination showed that theImplementation of chest x-ray examination for three

prevalence of active and inactive pulmonary TB

successive years. Kekkaku, (2007) 82, 19-25.

in males of Nakamura ward was 30 % in 60-698)

and 70-79 age groups, 2-3 % in 30-39 and 40-49

McAdam JM, Brickner PW, Scharer LL et al: Thespectrum of tuberculosis in a New York City men’sage groups. However, only 30 % was recognized in

shelter clinic1982-1988. Chest (1990) 97, 798-805

70-79 age group in Tenpaku ward. This means a 109)

years time difference between them. The prevalence10) Capewell S, France AJ, Anderson M et al: The diagno-of active and inactive pulmonary TB of females in

sis and management of tuberculosis in common hostel
dwellers. Tubercle, (1986) 67, 125-131

Nakamura ward was 26 % in the 70-79 age group.

11) Kumer D, Cirron KM, Leese J et al: Tuberculosis

However, it was under 17 % in all age groups inamong the homeless at a temporary shelter in London:

Tenpaku ward. This also means a 10 years time dif-report of a chest x-ray screening programme. J Epidem

ference between two wards.

Community Health (1955) 49, 629-633

Almost all Japanese people were thought to be
infected by the TB bacillus 50 years ago, between
1953-1967. However, we were only able to identify
30 % people with active and inactive TB lesions.
When we don’t know the incidence of registered
TB patients, or the positive rate of the Tuberculin
test, we can estimate the degree of the TB infiltrationin the group by analyzing the prevalence of active
and inactive TB lesions on the chest x-ray film.

Reference1)

Ministry of health and welfare: Report on the tuberculosis prevalence survey in Japan (1953) The Japan
Anti-Tuberculosis Association, 1955

2)

Ministry of health and welfare: Report on the tuberculosis prevalence survey in Japan (1968) The Japan
Anti-Tuberculosis Association, 1970

3)

Yamanaka K, Kondo T and Miyao M: Tuberculosis
among the homeless people of Nagoya, Japan. Respiratory Medicine (1994) 88, 763-769

4)

McAdam JM. Eratum Chest (1991) 792

Yamanaka K, Akashi T, and Miyao M: Tuberculosis
statistics among the homeless population in Nagoya

5

和文抄録

名古屋市住所不定者と非住所不定者における胸部レントゲン所見からの肺結核有所見率の比較研究
山中克己

＊＊＊

高鳥毛敏雄

１ 、名古屋市冬季越年施設の住所不定者の肺結核有所見率（活動性および治癒型）は30％であった。
その内活動性肺結核有病率は9.8％であった。
２ 、名 古屋市非住所不定者の男性の肺結核有所見率は、中村区では60-69、70-79歳の年齢階級で30％であり、天白区では70-79歳の年齢階級で30％であった。結核患者の登録罹患率は中村区が天白区より高率であり、中村区は天白区の約 2 倍であった。
３ 、名古屋市非住所不定者の女性の肺結核有所見率は、中村区では70-79歳で26％であり、天白区では70-79歳で17％であった。
４ 、すべての住民が結核菌に感染していたとしても、胸部間接レントゲン写真上で確認できる結核病巣は30％であった。
５ 、地域における胸部間接レントゲン写真上の年齢階級別の感染性および治癒型肺結核有所見率を分析することにより、地域の結核蔓延状況を推測できる。
キーワード：肺結核有所見率、住所不定者、胸部レントゲン写真＊名古屋学芸大学＊＊大阪大学大学院

管理栄養学部
医学系研究科6