Homelessness and health-related outcomes in the Republic of Ireland: a systematic review, meta-analysis and evidence map

Abstract

Aim To map existing research on homelessness and health in the Republic of Ireland, and to synthesize the evidence on housing-related disparities in health. Methods Peer-reviewed articles and conference abstracts published in English between 2012–2022 were retrieved from 11 bibliographic databases if they contained empirical data on homelessness and health in Ireland, and – in a subsequent screening stage – at least one measure of health disparity between the homeless and general populations. Reviewers extracted relative risks (RR), 95% confidence intervals (CI), and calculated pooled RR of comparable health disparities using pairwise random-effects meta-analyses. Results One hundred four articles contained empirical data on the health of homeless individuals residing in Ireland, addressing primarily substance use, addiction and mental health. Homelessness was associated with increased risk of illicit drug use (RR 7.33 [95% CI 4.2, 12.9]), reduced access to a general practitioner (GP) (RR 0.73 [CI 95% 0.71, 0.75]), frequent emergency department (ED) presentation (pooled RR 27.8 [95% CI 4.1, 189.8]), repeat presentation for self-harm (pooled RR 1.6 [95% CI 1.2, 2.0]) and premature departure from hospital (pooled RR 2.65 [95% CI 1.27, 5.53]). Conclusions Homelessness in Ireland is associated with reduced access to primary care and overreliance on acute care. Chronic conditions amongst homeless individuals are understudied.

“Just a knife wound this week, nothing too painful”:an ethnographic exploration of how homeless clients attending an urban primary care and addiction service view their own health and healthcare

“…Rising homelessness levels across Europe have brought increased attention to the health consequences of precarious housing. People experiencing homelessness (PEH) are at higher risk of premature mortality, disability, and chronic conditions but face reduced access to health services [1, 2]. A health equity perspective – the belief that everyone has the right to a fair and just opportunity to attain their full potential for health – emphasizes that housing-related health disparities are unnecessary and avoidable.…”

Priority healthcare needs amongst people experiencing homelessness in Dublin, Ireland: a qualitative evaluation of community expert experiences and opinions

“…People experiencing homelessness (PEH) are at higher risk of premature mortality, disability, and chronic conditions but face increased barriers to accessing health services 1 . In the Republic of Ireland, a country facing a worsening housing crisis, homelessness is associated with reduced access to a general practitioner (GP) and an overreliance on acute care 2 . PEH in Ireland are at increased risk of substance misuse, self-harm, frequent emergency department (ED) presentation, and psychiatric admission.…”

“…PEH in Ireland are at increased risk of substance misuse, self-harm, frequent emergency department (ED) presentation, and psychiatric admission. They are more likely to be hospitalised for venous thromboembolism (VTE), pneumonia/bronchitis, cellulitis, and seizure but less likely to complete their hospital admission 2 .…”

Priority healthcare needs amongst people experiencing homelessness in Dublin, Ireland: A qualitative evaluation of community expert experiences and opinions

“…Once in homelessness, an individuals’ health worsens and their life expectancy shortens [ 3 ]. PEH are at higher risk of premature mortality, disability, and chronic conditions and rely heavily on acute care [ 4 , 5 ]. PEH in Ireland are at increased risk of substance misuse, self-harm, frequent emergency department (ED) presentation, and psychiatric admission.…”

“…PEH in Ireland are at increased risk of substance misuse, self-harm, frequent emergency department (ED) presentation, and psychiatric admission. They are more likely to be hospitalised for venous thromboembolism (VTE), pneumonia/bronchitis, cellulitis, and seizure but less likely to complete their hospital admission [ 5 ]. Despite facing adverse health outcomes, PEH experience reduced access to care due to a variety of external barriers including physical proximity to services; administrative barriers such as queues, appointment systems, and complicated application processes for care; and stigma and judgement from healthcare providers [ 6 ].…”