Cardiovascular disease in homeless versus housed individuals: a systematic review of observational and interventional studies

Al-Shakarchi, Nader; Evans, Hannah; Luchenski, Serena; Story, Alistair; Banerjee, Amitava

doi:10.1136/heartjnl-2020-316706

Cited by 47 publications

(35 citation statements)

References 26 publications

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“…13 That sofa surfing was the most common type of experience that supports this hypothesis. We did, however, replicate associations between homelessness and greater socioeconomic disadvantage, 12 mental health problems 14 and substance use, 15 but these differences were not physiologically expressed.…”

Section: Discussioncontrasting

confidence: 58%

“…These results contrast with those from case-control studies which have consistently found elevated biomedical risks in people who are homeless at the time of assessment. 12 That this consistent pattern of elevated risk was not apparent suggests risks may have resolved to normative levels as participants had been rehoused. The household sampling used in the present cohort is likely to have resulted in a less extreme homeless experience than previous studies with rough sleepers and those attending homeless shelters.…”

Section: Discussionmentioning

confidence: 99%

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Homelessness in early adulthood and biomedical risk factors by middle-age: the 1970 British Cohort Study

White

Hamer

Batty

2021

J Epidemiol Community Health

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BackgroundHomelessness has been linked to premature mortality but the relationship with biomedical risk factors is uncertain.MethodsWe analysed data from 8581 participants in the 1970 British Birth Cohort Study. Homelessness and type of experience were self-reported at 30 years of age. Nine biomarkers outcomes were collected at 46 years of age: body mass index (BMI), blood pressure, total and high-density cholesterol, triglycerides, glycated haemoglobin, C-reactive protein (CRP), insulin-like growth factor 1 and we computed the 10-year risk for coronary heart disease.ResultsBy 30 years of age, 5.8% of participants had been homeless with sofa surfing the most common experience (4.3%). Homelessness was associated with socioeconomic disadvantage, mental health problems and substance use in early adulthood, but these differences were not expressed in biomarkers. After accounting for early adulthood characteristics, residing in a bed and breakfast was associated with a higher BMI (0.59, 95% CI 0.13 to 1.05) and CRP (0.16, 95% CI 0.04 to 0.29), squatting with a lower BMI (−1.69, 95% CI –3.08 to −0.21) and rough sleeping with a higher 10-year risk of coronary heart disease (0.03, 95% CI 0.01 to 0.05).ConclusionsExposure to homelessness in early adulthood was essentially unrelated to biomarkers in middle age. Inconsistent links were found for specific types of experience.

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Section: Discussioncontrasting

confidence: 58%

Section: Discussionmentioning

confidence: 99%

Homelessness in early adulthood and biomedical risk factors by middle-age: the 1970 British Cohort Study

White

Hamer

Batty

2021

J Epidemiol Community Health

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“…Hospitalization due to any cause among PEH with HIV infection shifted from “convincing evidence” to “highly suggestive evidence”, non-adherence to antiretroviral therapy (ART) among PEH with HIV infection shifted from “suggestive evidence” to “weak evidence”, and mortality due to any cause among PEH with SUD up-graded from “no significant evidence” to “highly suggestive evidence”. Please refer to Additional file 1 : Table S4 [ 211 , 214 , 217 , 219 ].…”

Section: Resultsmentioning

confidence: 99%

Homelessness and health-related outcomes: an umbrella review of observational studies and randomized controlled trials

Fornaro

Dragioti

Prisco

et al. 2022

BMC Med

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Background Homelessness has been associated with multiple detrimental health outcomes across observational studies. However, relatively few randomized controlled trials (RCTs) have been conducted on people who experience homelessness (PEH). Thus, this umbrella review ranked the credibility of evidence derived from systematic reviews (SRs) and meta-analyses (MAs) of observational studies investigating the associations between homelessness and any health outcome as well as RCTs targeting health needs in this population. Methods Several databases were systematically searched from inception through April 28, 2021. Any SR and/or MA reporting quantitative data and providing a control group were eligible for inclusion. The credibility of the evidence derived from observational studies was appraised by considering the significance level of the association and the largest study, the degree of heterogeneity, the presence of small-study effects as well as excess significance bias. The credibility of evidence was then ranked in five classes. For SRs and/or MAs of RCTs, we considered the level of significance and whether the prediction interval crossed the null. The AMSTAR-2 and AMSTAR-plus instruments were adopted to further assess the methodological quality of SRs and/or MAs. The Newcastle-Ottawa Scale (NOS) was employed to further appraise the methodological quality of prospective cohort studies only; a sensitivity analysis limited to higher quality studies was conducted. Results Out of 1549 references, 8 MAs and 2 SRs were included. Among those considering observational studies, 23 unique associations were appraised. Twelve of them were statistically significant at the p≤0.005 level. Included cases had worst health-related outcomes than controls, but only two associations reached a priori-defined criteria for convincing (class I) evidence namely hospitalization due to any cause among PEH diagnosed with HIV infection, and the occurrence of falls within the past year among PEH. According to the AMSTAR-2 instrument, the methodological quality of all included SRs and/or MAs was “critically low.” Interventional studies were scant. Conclusion While homelessness has been repeatedly associated with detrimental health outcomes, only two associations met the criteria for convincing evidence. Furthermore, few RCTs were appraised by SRs and/or MAs. Our umbrella review also highlights the need to standardize definitions of homelessness to be incorporated by forthcoming studies to improve the external validity of the findings in this vulnerable population.

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“…As a consequence of the ageing of the population, the number of elderly people who experience homelessness is also increasing in many developed countries, which has implications for the prevalence of age-related chronic diseases in the homeless population [2]. Homeless people are also at greater risk of developing multiple morbidities [12], including respiratory and circulatory conditions [13][14][15]; injury (particularly through violence) [16], poor oral health [17], feet problems [2]. Homeless individuals have difficulties managing diseases, in some countries many of them do not have health insurance, they cannot access specific medical care, and they are more likely to use the emergency services [18,19].…”

Section: Introductionmentioning

confidence: 99%

Health status and health behaviour of the Hungarian homeless people

et al. 2021

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Background Homelessness has risen recently in Europe, but there is lack of comprehensive health data on this population. Our aim was to characterize the health of the Hungarian homeless population. Methods We performed a health survey with 453 homeless individuals. The results were compared to the age and sex standardized data of the general Hungarian population and its lowest income quintile from the European Health Interview Survey 2014. The differences by the ETHOS classification within the homeless population were also studied. Results Significantly fewer homeless people reported good health status than in the general population or in its lowest income quintile (p< 0.001). Of the participants 70% had at least one chronic disease, only 41% of them visited a GP and 35% took medication in the previous 12 months. While 59% of the lowest income quintile and 50% of the general population had at least one chronic disease, almost all of them visited a physician and took medication. The highest prevalence of morbidity (80%) and multimorbidity (46%) was reported in the houseless group. The majority of the homeless people were current smokers, the prevalence was much higher than in the two reference populations (p< 0.001). The prevalence of heavy drinkers was the highest among the roofless participants (40%). Conclusions Homeless people have much poorer health and they utilize health services less than the most disadvantaged quintile of the general population. There is a clear social gradient within the homeless population, as well, which calls for integrated approaches for specific interventions to improve their health.

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Cardiovascular disease in homeless versus housed individuals: a systematic review of observational and interventional studies

Cited by 47 publications

References 26 publications

Homelessness in early adulthood and biomedical risk factors by middle-age: the 1970 British Cohort Study

Homelessness in early adulthood and biomedical risk factors by middle-age: the 1970 British Cohort Study

Homelessness and health-related outcomes: an umbrella review of observational studies and randomized controlled trials

Health status and health behaviour of the Hungarian homeless people

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