Identification of Cardiovascular Risk Factors in Homeless Adults

Szerlip, Molly; Szerlip, Harold M.

doi:10.1097/00000441-200211000-00002

Cited by 66 publications

(64 citation statements)

References 19 publications

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“…The South Riverdale population was sampled through a family practice unit, likely accounting for the greater proportion of individuals who were overweight, had diabetes and who were at very high risk for CVD. However, our results are in keeping with previous studies that reported elevated CVD risk factor levels in the inner city (8,9), and higher mortality rates due to CVD in disadvantaged populations (6). This sample may also be more health conscious, biasing our results toward the overestimation of knowledge level in the inner city sample.…”

Section: Limitationssupporting

confidence: 90%

“…Despite the fact that inner-city populations experience higher mortality rates from CVD (6) and have higher levels of CVD risk factors (7,8), to our knowledge, the present study is one of the first to directly compare CVD risk factor knowledge between an inner-city and a general adult population in Canada. Our results demonstrate that individuals in the inner city are equally aware, if not more aware, of the causes of CVD as the general population.…”

Section: Discussionmentioning

confidence: 98%

“…The mortality rate from CVD has been declining slightly in North America over the past four decades (3,4) due, in part, to a parallel decrease in the prevalence of major CVD risk factors and improved care of patients with known CVD (2,5). Despite this decline, there are specific segments of the population, such as disadvantaged, urban, inner-city populations in the United States and Canada, that have a significantly higher CVD mortality rate (6) and higher prevalence of CVD risk factors (7)(8)(9). The causes for this inequality are not well understood, but may stem in part from the inadequate control of CVD risk factors.…”

mentioning

confidence: 99%

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Cardiovascular risk factor awareness in a disadvantaged inner-city population – implications for preventive strategies

Wong

Garcia

Barr

et al. 2008

Canadian Journal of Cardiology

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, RH Glazier, BL Abramson. Cardiovascular risk factor awareness in a disadvantaged inner-city population -implications for preventive strategies. Can J Cardiol 2008;24(9):677-682.BACKGROUND: Disadvantaged inner-city populations have significantly higher cardiovascular disease (CVD) mortality rates than the general population. Whether a deficiency in the level of awareness, a prerequisite for change, exists that contributes to this socioeconomic divide has not been well established. OBJECTIVES: To address CVD risk by assessing the knowledge of CVD risk factors of an inner-city population and comparing it with that of the general population by establishing determinants of CVD knowledge and identifying potential barriers to CVD risk factor reduction in the inner city. METHODS: Cross-sectional survey of 136 consecutive patients 40 years of age and older attending an inner-city community health centre. The comparison group consisted of 807 age-matched respondents from the Canadian Heart Health Study, a random sample survey of the general adult Canadian population. Outcome measures included CVD risk factor knowledge, CVD risk factor prevalence and barriers to reducing CVD risk. RESULTS: There was no significant difference between inner-city respondent ability to name five of the seven CVD risk factors compared with the general population. Two CVD risk factors were more readily recalled by the inner-city group (lack of exercise, P<0.001; heredity, P=0.003). The average number of risk factors named by an individual from the inner city was significantly higher than the general population (3.1 versus 2.6; P<0.001). Among the inner-city respondents, socioeconomic factors, including higher education level (OR 5.224; P<0.001) and being married (OR 3.651; P=0.008), were independently related to good CVD knowledge; high CVD risk was not related. Lack of motivation (57%), lack of time (34%) and lack of money (30%) were commonly reported as barriers to addressing CVD risk. CONCLUSIONS: Elevated CVD risk in the inner city may not be attributable to a deficiency in the level of awareness. However, the relationship between socioeconomic status and knowledge is maintained within the lowest social class tier. The identification of barriers linked to inner-city life has implications for prevention of CVD in the inner city; results suggest that interventions that combine health education with motivational approaches, while necessary, may not be sufficient.

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Section: Limitationssupporting

confidence: 90%

Section: Discussionmentioning

confidence: 98%

mentioning

confidence: 99%

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Cardiovascular risk factor awareness in a disadvantaged inner-city population – implications for preventive strategies

Wong

Garcia

Barr

et al. 2008

Canadian Journal of Cardiology

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“…11 While white women are least likely to experience homelessness, those who are homeless comprise a uniquely vulnerable group with respect to psychosocial risk factors that are distinct from being black or male. 12,13 Homeless adults face barriers to receiving health care, 14,15 suffer from chronic medical conditions including hypertension, [16][17][18] and experience premature mortality from cardiovascular disease. 19,20 Studies among unstably housed adults demonstrate similar barriers to receiving health care, 1,21 but little is known about health outcomes.…”

Section: Introductionmentioning

confidence: 99%

Housing Instability and Incident Hypertension in the CARDIA Cohort

et al. 2012

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Housing instability, a growing public health problem, may be an independent environmental risk factor for hypertension, but limited prospective data exist. We sought to determine the independent association of housing instability in early adulthood (year 5, 1990-1991) and incident hypertension over the subsequent 15 years of follow-up (years 7, 10, 15, and 20) in the Coronary Artery Risk Development in Young Adults (CARDIA) study (N=5,115). Because causes of inadequate housing and its effects on health are thought to vary by race and sex, we hypothesized that housing instability would exert a differential effect on incident hypertension by race and sex. At year 5, all CARDIA participants were asked about housing and those free of hypertension were analyzed (N=4,342). We defined housing instability as living in overcrowded housing, moving frequently, or living doubled up. Of the 4,342 participants, 8.5 % were living in unstable housing. Across all participants, housing instability was not associated with incident hypertension (incidence rate ratio (IRR), 1.1; 95 % CI, 0.9-1.5) after adjusting for demographics, socioeconomic status, substance use, social factors, body mass index, and study site. However, the association varied by race and sex (p value for interaction, G0.001). Unstably housed white women had a hypertension incidence rate 4.7 times (IRR, 4.7; 95 % CI, 2.4-9.2) that of stably housed white women in adjusted analysis. There was no association among white men, black women, or black men. These findings suggest that housing instability may be a more important risk factor among white women, and may act independently or as a marker for other psychosocial stressors (e.g., stress from intimate partner violence) leading to development of hypertension. Studies that examine the role of these psychosocial stressors in development of hypertension risk among unstably housed white women are needed.

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“…In comparison with the general population, mortality rates are reported to be higher among the homeless and premature death is more common 9,10,11 , especially due to cardiovascular disease 11,12 . In addition to a high prevalence of diabetes and hypercholesterolemia, the increased risk of cardiovascular disease has been attributed essentially to a high prevalence of hypertension and substance abuse 12,13,14,15,16 . Several studies reported prevalence of hypertension among the homeless ranging from 14% to 51% 14,15,17,18,19,20,21 , and prevalence of tobacco and alcohol consumption of almost 80% and 30% respectively 12,14,22 .…”

Section: Introductionmentioning

confidence: 99%

Risk factors for cardiovascular disease among the homeless and in the general population of the city of Porto, Portugal

et al. 2012

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We described the distribution of risk factors for cardiovascular disease among homeless people living in the city of Porto, Portugal. Comparisons were made between subsamples of homeless people recruited in different settings and between the overall homeless sample group and a sample of the general population. All "houseless" individuals attending one of two homeless hostels or two institutions providing meal programs on specific days were invited to participate and were matched with subjects from the general population. We estimated sex, age and education-adjusted prevalence ratios or mean differences. The prevalence of previous illicit drug consumption and imprisonment was almost twice as high among the homeless from institutions providing meal programs. This group also showed lower mean systolic and diastolic blood pressure. Prevalence of smoking was almost 50% higher in the overall homeless group. Mean body mass index and waist circumference were also lower in the homeless group and its members were almost five times less likely to report dyslipidemia. Our findings contribute to defining priorities for interventions directed at this segment of society and to reducing inequalities in this extremely underprivileged population.

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Identification of Cardiovascular Risk Factors in Homeless Adults

Cited by 66 publications

References 19 publications

Cardiovascular risk factor awareness in a disadvantaged inner-city population – implications for preventive strategies

Cardiovascular risk factor awareness in a disadvantaged inner-city population – implications for preventive strategies

Housing Instability and Incident Hypertension in the CARDIA Cohort

Risk factors for cardiovascular disease among the homeless and in the general population of the city of Porto, Portugal

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