Health-related quality of life and prevalence of six chronic diseases in homeless and housed people: a cross-sectional study in London and Birmingham, England

Abstract

ObjectivesTo compare health-related quality of life and prevalence of chronic diseases in housed and homeless populations.DesignCross-sectional survey with an age-matched and sex-matched housed comparison group.SettingHostels, day centres and soup runs in London and Birmingham, England.ParticipantsHomeless participants were either sleeping rough or living in hostels and had a history of sleeping rough. The comparison group was drawn from the Health Survey for England. The study included 1336 homeless and 13 360 housed participants.Outcome measuresChronic diseases were self-reported asthma, chronic obstructive pulmonary disease (COPD), epilepsy, heart problems, stroke and diabetes. Health-related quality of life was measured using EQ-5D-3L.ResultsHoused participants in more deprived neighbourhoods were more likely to report disease. Homeless participants were substantially more likely than housed participants in the most deprived quintile to report all diseases except diabetes (which had similar prevalence in homeless participants and the most deprived housed group). For example, the prevalence of chronic obstructive pulmonary disease was 1.1% (95% CI 0.7% to 1.6%) in the least deprived housed quintile; 2.0% (95% CI 1.5% to 2.6%) in the most deprived housed quintile; and 14.0% (95% CI 12.2% to 16.0%) in the homeless group. Social gradients were also seen for problems in each EQ-5D-3L domain in the housed population, but homeless participants had similar likelihood of reporting problems as the most deprived housed group. The exception was problems related to anxiety, which were substantially more common in homeless people than any of the housed groups.ConclusionsWhile differences in health between housed socioeconomic groups can be described as a ‘slope’, differences in health between housed and homeless people are better understood as a ‘cliff’.

Homeless persons' experiences of health‐ and social care: A systematic integrative review

“…Homelessness is an increasing problem worldwide (EU, ; US, ), and previous research highlights that persons experiencing homelessness are disproportionately affected by physical and mental illness, substance abuse and long‐term burden of chronic diseases compared to housed persons (van Dongen et al, ; Lebrun‐Harris et al, ; Lewer et al, ). Homeless populations, that is, individuals without permanent housing who may live on the streets; stay in a shelter, mission, single room occupancy facilities, abandoned building or vehicle; or in any other unstable or non‐permanent situation (US, ), face huge health inequities across a wide range of health conditions (Aldridge et al, ).…”

“…Homeless populations, that is, individuals without permanent housing who may live on the streets; stay in a shelter, mission, single room occupancy facilities, abandoned building or vehicle; or in any other unstable or non‐permanent situation (US, ), face huge health inequities across a wide range of health conditions (Aldridge et al, ). Persons experiencing homelessness are three times more likely to report chronic diseases with asthma, COPD, epilepsy and heart problems being prevalent (Lewer et al, ). Older persons (>50) experiencing homelessness have multiple health problems that remain unaddressed by healthcare services, often lack social support and do not explicitly express their own healthcare needs (van Dongen et al, ), resulting in higher use of acute care.…”

“…The origins of homelessness are multi-faceted, both on individual and structural levels, for example the ageing population (van Dongen et al, 2019;Fazel et al, 2014), changes in the housing market with shifts in family structures (NBHW, 2017), migration (EU, 2013), rising costs for housing (NBHW, 2017) and poor health (van Dongen et al, 2019;Fazel et al, 2014;Lewer et al, 2019). A growing body of research concludes that homelessness is associated with heavy costs for society with regards to public health, social and legal services (Basu, Kee, Buchanan, & Sadowski, 2012;Fuehrlein et al, 2015;Larimer et al, 2009;Mitchell, Leon, Byrne, Lin, & Bharel, 2017;Suh et al, 2016).…”

From health for all to leaving no-one behind: public health agencies, inclusion health, and health inequalities

“…8 For example, the prevalence of long-term conditions, such as asthma and chronic obstructive pulmonary disease, follows the traditional gradient through levels of deprivation in the housed populations of London and Birmingham; however, prevalence in homeless people is substantially higher than in housed individuals from the most deprived quintile. 8 Common experiences cut across inclusion health groups. Most have been or are exposed to multiple, overlapping risk factors, such as adverse childhood experiences, trauma, and poverty.…”

Physical functioning limitations and physical activity of people experiencing homelessness: A scoping review

“…Common chronic diseases such as chronic obstructive pulmonary disease, asthma, epilepsy, heart disease and stroke are substantially more prevalent among people experiencing homelessness compared to housed individuals 8 . External factors as well as chronic diseases have a multi-system effect with reported accelerated ageing 9 and early onset of geriatric conditions 10 .…”