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Comparative Study
. 2019 Apr 24;9(4):e025192.
doi: 10.1136/bmjopen-2018-025192.

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

Dan Lewer  1   2   3 , Robert W Aldridge  2   3 , Dee Menezes  2 , Clare Sawyer  4 , Paola Zaninotto  1 , Martin Dedicoat  5 , Imtiaz Ahmed  6 , Serena Luchenski  1   2   3 , Andrew Hayward  1   3 , Alistair Story  3   4
Affiliations
Comparative Study

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

Dan Lewer et al. BMJ Open. .

Abstract

Objectives: To compare health-related quality of life and prevalence of chronic diseases in housed and homeless populations.

Design: Cross-sectional survey with an age-matched and sex-matched housed comparison group.

Setting: Hostels, day centres and soup runs in London and Birmingham, England.

Participants: Homeless 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 measures: Chronic 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.

Results: Housed 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.

Conclusions: While 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'.

Keywords: epidemiology; homelessness; inequality; public health.

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Conflict of interest statement

Competing interests: AH is Trustee of the UK-based charity ’Pathway (healthcare for homeless people)'. AS is Clinical Lead for the Find & Treat Service; data were collected from homeless clients of this service.

Figures

Figure 1
Figure 1
Percentage reporting long-term conditions, by age group. COPD, chronic obstructive pulmonary disease.
Figure 2
Figure 2
Prevalence of long-term conditions (top panel) and prevalence ratios (bottom panel), with 95% CIs. COPD, chronic obstructive pulmonary disease; IMD, index of multiple deprivation.
Figure 3
Figure 3
Histograms of EQ-5D-Visual Analogue Scale score, by homeless/housed status. Horizontal lines show median and 25% and 75% quantiles.
Figure 4
Figure 4
Health-related quality of life: prevalence of problems by deprivation group (top panel) and prevalence ratios (bottom panel), with 95% CIs. IMD, index of multiple deprivation.
See this image and copyright information in PMC

References

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