Is homeless health just the bottom of the deprivation slope?
Among 1336 homeless and 13,360 housed adults, chronic diseases jumped far above even the most deprived housed quintile (COPD 14% vs 2%), which the authors call a health ‘cliff’.
Source
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
Study at a glance
- Design
- Cross-sectional — Cross-sectional survey of homeless people in London and Birmingham, age- and sex-matched to Health Survey for England housed participants by deprivation quintile.
- N
- N=14696 · 1336 homeless and 13,360 housed participants.
- Population
- Adults sleeping rough or in hostels with a history of sleeping rough, versus urban housed adults from HSE.
- Outcome
- Self-reported asthma, COPD, epilepsy, heart problems, stroke, diabetes, and EQ-5D-3L health-related quality of life.
Structured fields used in claim comparison tables when every cited study has a complete layer.
What they did
Surveyed people sleeping rough or in hostels in London and Birmingham and compared them with an age- and sex-matched Health Survey for England sample, reporting six self-reported chronic diseases and EQ-5D-3L problems by housed deprivation quintile.
What they found
Housed disease rose with deprivation, but homeless people were much more likely than the most deprived housed quintile to report every disease except diabetes. COPD was 1.1% (least deprived housed), 2.0% (most deprived housed), and 14.0% (homeless). EQ-5D problems otherwise resembled the most deprived housed group, except anxiety, which was far more common (prevalence ratio 3.8 vs 1.8 for most vs least deprived housed).
The limits
What it doesn't show
Self-report and a cross-section cannot prove homelessness caused disease, and hostel/day-centre sampling misses some street populations.
Key terms
- Health ‘cliff’
- Authors’ contrast: housed deprivation is a slope, homeless vs housed gaps are a cliff.
- EQ-5D-3L
- Five-domain health-related quality-of-life instrument used here.
- COPD
- Chronic obstructive pulmonary disease; 14% in homeless vs 2% in most deprived housed.
- Health Survey for England
- National household survey supplying the matched housed comparison group.
- IMD quintile
- Index of Multiple Deprivation grouping used for housed social gradients.
- Sleeping rough
- Homeless inclusion required current or past rough sleeping, including hostel residents.
Flashcards
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Homeless sample size was about:
Common questions
How large were the groups?
1336 homeless and 13,360 housed participants.
Where were homeless people recruited?
Hostels, day centres, and soup runs in London and Birmingham.
Which disease did not show a homeless excess vs most-deprived housed?
Diabetes had similar prevalence.
Which EQ-5D domain was uniquely worse?
Anxiety problems, prevalence ratio 3.8 vs housed least-deprived.
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