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Meta-Analysis
. 2020 Oct;106(19):1483-1488.
doi: 10.1136/heartjnl-2020-316706. Epub 2020 Jul 14.

Cardiovascular disease in homeless versus housed individuals: a systematic review of observational and interventional studies

Nader James Al-Shakarchi  1 , Hannah Evans  2 , Serena A Luchenski  3 , Alistair Story  2   4 , Amitava Banerjee  5   6   7
Affiliations
Meta-Analysis

Cardiovascular disease in homeless versus housed individuals: a systematic review of observational and interventional studies

Nader James Al-Shakarchi et al. Heart. 2020 Oct.

Abstract

Objectives: To identify: (i) risk of cardiovascular disease (CVD) in homeless versus housed individuals and (ii) interventions for CVD in homeless populations.

Methods: We conducted a systematic literature review in EMBASE until December 2018 using a search strategy for observational and interventional studies without restriction regarding languages or countries. Meta-analyses were conducted, where appropriate and possible. Outcome measures were all-cause and CVD mortality, and morbidity.

Results: Our search identified 17 articles (6 case-control, 11 cohort) concerning risk of CVD and none regarding specific interventions. Nine were included to perform a meta-analysis. The majority (13/17, 76.4%) were high quality and all were based in Europe or North America, including 765 459 individuals, of whom 32 721 were homeless. 12/17 studies were pre-2011. Homeless individuals were more likely to have CVD than non-homeless individuals (pooled OR 2.96; 95% CI 2.80 to 3.13; p<0.0001; heterogeneity p<0.0001; I2=99.1%) and had increased CVD mortality (age-standardised mortality ratio range: 2.6-6.4). Compared with non-homeless individuals, hypertension was more likely in homeless people (pooled OR 1.38-1.75, p=0.0070; heterogeneity p=0.935; I2=0.0%).

Conclusions: Homeless people have an approximately three times greater risk of CVD and an increased CVD mortality. However, there are no studies of specific pathways/interventions for CVD in this population. Future research should consider design and evaluation of tailored interventions or integrating CVD into existing interventions.

Keywords: global healthcare delivery; health care delivery; quality and outcomes of care.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses diagram representing the systematic literature search.
Figure 2
Figure 2
Forest plots of ORs of cardiovascular disease (CVD) (International Classification of Diseases, Tenth Revision definition) in homeless vs housed individuals from (A) all studies in meta-analysis (n=9), (B) North American studies (n=6) and (C) European studies (n=3). (D) Forest plot of ORs of hypertension (a subset of CVD) (n=2).
See this image and copyright information in PMC

Comment in

References

    1. Luchenski S, Maguire N, Aldridge RW, et al. . What works in inclusion health: overview of effective interventions for marginalised and excluded populations. Lancet 2018;391:266–80. 10.1016/S0140-6736(17)31959-1 - DOI - PubMed
    1. Aldridge RW, Story A, Hwang SW, et al. . Morbidity and mortality in homeless individuals, prisoners, sex workers, and individuals with substance use disorders in high-income countries: a systematic review and meta-analysis. Lancet 2018;391:241–50. 10.1016/S0140-6736(17)31869-X - DOI - PMC - PubMed
    1. Aldridge RW, Menezes D, Lewer D, et al. . Causes of death among homeless people: a population-based cross-sectional study of linked hospitalisation and mortality data in England. Wellcome Open Res 2019;4:49. 10.12688/wellcomeopenres.15151.1 - DOI - PMC - PubMed
    1. Lewer D, Aldridge RW, Menezes D, et al. . 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. BMJ Open 2019;9:e025192. 10.1136/bmjopen-2018-025192 - DOI - PMC - PubMed
    1. GBD 2017 DALYs and HALE Collaborators Global, regional, and national disability-adjusted life-years (DALYs) for 359 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990-2017: a systematic analysis for the global burden of disease study 2017. Lancet 2018;392:1859–922. 10.1016/S0140-6736(18)32335-3 - DOI - PMC - PubMed

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