To the Editor.—
A recent study of epidemic drug-resistant tuberculosis among the homeless1 helps to correct any misunderstanding that this phenomenon in the United States is exclusively an ethnic and racial one. In the past, its occurrence among ethnic-racial groups has received prominent attention, as for example among Mexican-Americans in southern Texas, among Vietnamese and other Asian immigrants in the state of Washington and in Canada, and among newly admitted Haitian immigrants in Florida.By contrast, at various times other studies have attributed a prominent influence to local circumstances and to certain nonethnic characteristics of populations in which drug-resistant tuberculosis has been identified. In Hawaii, for example,2 between 1977 and 1981, with a high tuberculosis rate and strict immigration health policies, only 4.7% of tuberculous isolates were reported to be primary drug-resistant and 5.3% secondarily resistant, despite a heavy Oriental immigration. Variable frequencies of such drug resistance have
Lebowitz CZ. Frequency of Drug-Resistant Mycobacteria. JAMA. 1985;254(24):3424–3425. doi:10.1001/jama.1985.03360240036024
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