Multimorbidity among People Experiencing Homelessness—Insights from Primary Care Data
Abstract
:1. Introduction
1.1. Homeless Healthcare
1.2. Aim of This Study
2. Methods
2.1. Study Design
2.2. Data Sources and Variables
2.3. Data Analysis
3. Results
3.1. Demographics
3.2. Prevalence of Health Conditions
3.2.1. Mental Health Conditions
3.2.2. Alcohol and Other Drug Use Disorders
3.2.3. Physical Health Conditions
3.3. Dual Diagnosis and Multimorbidity
4. Discussion
4.1. Mental Health Conditions
4.2. AOD Use Disorders
4.3. Physical Health Conditions
4.4. Implications of Findings
4.4.1. Implications for Healthcare Access and Clinical Care
4.4.2. Implications for Public Health
4.4.3. Implications for Public Policy and Action on Homelessness
4.5. Limitations
4.6. Future Research
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Acknowledgments
Conflicts of Interest
References
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Study | Population and Location | Data Type |
---|---|---|
Australian Comparison Studies | ||
Harrison et al. [15] | 43,501 GP patients in 1449 GP clinics across Australia | GP survey based on clinical records of consecutive patients |
NPS MedicineWise [27] | 2,893,532 GP patients in 3255 GP clinics across Australia | Clinical records |
International Homelessness Comparison Studies | ||
Bowen et al. [28] | 928 homeless GP patients in the West Midlands, England | Clinical records |
Keogh et al. [13] | 105 homeless GP patients in 4 health clinics across Dublin | Self-reported via 133-item questionnaire |
Zeitler et al. [12] (and Queen et al. [16] for additional conditions not presented in Zeitler) | 133 homeless GP patients in Glasgow and 150 homeless GP patients in Edinburgh | Clinical records |
Total | Aboriginal 1 | Non-Aboriginal 1 | |
---|---|---|---|
Number of patients: n (%) | 2068 | 492 (23.8) | 1534 (74.2) |
Sex 2: n (%) | |||
Male | 1329 (64.3) | 234 (47.6) | 1073 (70.1) |
Female | 736 (35.6) | 258 (52.4) | 458 (29.9) |
Age 3,4: mean ± SD (range); years | |||
Overall | 42.4 ± 12.8 (0.6–82.2) | 41.9 ± 12.1 (0.6–81.5) | 42.8 ± 12.9 (0.8–82.2) |
Male | 44.2 ± 12.2 (0.6–82.2) | 43.7 ± 10.8 (0.6–78.4) | 44.4 ± 12.4 (1.1–82.2) |
Female | 39.3 ± 13.2 (0.8–81.5) | 40.2 ± 12.9 (1.2–81.5) | 39.1 ± 13.2 (0.8–81.1) |
Age category 4: n (%) | |||
<25 | 187 (9.1) | 39 (7.9) | 139 (9.1) |
25–44 | 976 (47.3) | 245 (49.8) | 713 (46.5) |
45–64 | 844 (40.9) | 202 (41.1) | 629 (41.0) |
65–74 | 50 (2.4) | 3 (0.6) | 47 (3.1) |
≥75 | 8 (0.4) | 3 (0.6) | 5 (0.3) |
This Study (n = 2068) | Bowen et al. [28] (n = 928) | Keogh et al. [13] (n = 105) 1 | Zeitler et al. [12] | |||
---|---|---|---|---|---|---|
Edinburgh (n = 150) | Glasgow (n = 133) | |||||
n | % | % | % | % | % | |
Mental Health Conditions | ||||||
Depression | 940 | 45.5 | 11.6 | 49.5 | 55.3 | 33.1 |
Anxiety disorder | 557 | 26.9 | 36.2 | 64.7 | 15.0 | |
PTSD | 279 | 13.5 | 13.3 | 3.8 | ||
Schizophrenia | 218 | 10.5 | 13.3 | 7.5 3 | ||
Bipolar disorder | 143 | 6.9 | 5.7 | |||
EUPD | 104 | 5.0 | 14.7 2 | 6.8 2 | ||
AOD Use Disorders | ||||||
Amphetamine use disorder | 534 | 25.8 | ||||
Alcohol use disorder | 525 | 25.4 | 21.3 | 36.7 | 54.1 | |
Opiate use disorder | 359 | 17.4 | 53.3 4 | 46.6 4 | ||
Benzodiazepine use disorder | 330 | 16.0 | 34.0 | 22.6 | ||
Physical Health Conditions | ||||||
Chronic pain | 545 | 26.4 | 28.0 | 18.1 | ||
Chronic liver disease | 471 | 22.8 | 4.7 | 1.5 | ||
Hepatitis C | 434 | 21.0 | 6.3 | 23.1 | 24.8 | |
Low back pain | 322 | 15.6 | 17.1 | |||
Asthma | 265 | 12.8 | 4.2 | 20.9 | ||
Hypertension | 233 | 11.3 | 4.2 | 21.9 | ||
GORD | 204 | 9.9 | 26.7 | |||
Diabetes type II | 153 | 7.4 | 2.8 6 | 7.6 6 | ||
Osteoarthritis | 153 | 7.4 | 5.7 7 | |||
Dyslipidaemia | 142 | 6.9 | ||||
COPD | 123 | 5.9 | 2.9 | |||
Epilepsy | 121 | 5.9 | 7.6 | 6.0 | 3.0 | |
Brain injury | 82 | 4.0 | 3.3 5 | |||
Dermatitis/Eczema | 73 | 3.5 | 52.3 | 18.7 | 9.8 |
This Study (n = 2068) | Harrison et al. (n = 43,501) [15] | NPS MedicineWise (n = 2,893,532) [27] | ||
---|---|---|---|---|
n | % | % | % | |
Mental Health Conditions | ||||
Depression | 940 | 41.3 | 8.0 | 13.9 |
Anxiety disorder | 557 | 22.8 | 5.8 | 12.3 |
PTSD | 279 | 11.3 | ||
Schizophrenia | 218 | 8.7 | 0.5 | |
EUPD | 104 | 5.8 | ||
Bipolar disorder | 143 | 5.4 | 0.9 | |
AOD Use Disorders | ||||
Amphetamine use disorder | 534 | 21.2 | ||
Alcohol use disorder | 524 | 21.0 | ||
Opiate use disorder | 359 | 12.3 | ||
Benzodiazepine use disorder | 330 | 11.0 | ||
Physical Health Conditions | ||||
Chronic pain | 543 | 21.7 | ||
Chronic liver disease | 471 | 16.2 | ||
Hepatitis C | 434 | 14.5 | ||
Hypertension | 233 | 13.4 | 12.4 | 16.3 |
Low back pain | 321 | 12.8 | 4.1 | 14.5 |
Asthma | 265 | 12.6 | 5.2 | 12.1 |
Osteoarthritis | 153 | 8.9 | 9.5 | 9.4 |
GORD | 204 | 8.1 | 4.9 | 12.1 |
Diabetes type II | 153 | 7.3 | 4.2 | 5.4 |
Dyslipidaemia | 142 | 7.2 | 8.2 1 | 13.7 |
COPD | 123 | 7.1 | 1.6 | 2.5 |
Epilepsy | 121 | 4.4 | ||
Dermatitis/Eczema | 73 | 4.4 | 7.4 | |
Brain injury | 82 | 3.6 |
n (%) | Total (n = 2068) | Aboriginal 1 (n = 492) | Non-Aboriginal 1 (n = 1534) |
---|---|---|---|
Mental health (MH) condition | 1395 (67.5) | 263 (53.5) | 1113 (72.6) * |
AOD use disorder | 1274 (61.6) | 285 (57.9) | 973 (63.4) * |
Chronic physical health condition | 1402 (67.8) | 310 (63.0) | 1066 (69.5) * |
Dual diagnosis (MH + AOD) | 988 (47.8) | 184 (37.4) | 794 (51.8) * |
MH + Physical comorbidity | 1058 (51.2) | 199 (40.4) | 848 (55.3) * |
AOD + Physical comorbidity | 968 (46.8) | 217 (44.1) | 739 (48.2) |
Tri-morbidity (MH + AOD + Physical) | 788 (38.1) | 153 (31.1) | 627 (40.9) * |
n (%) | Total (n = 2068) | Aboriginal 1 (n = 492) | Non-Aboriginal 1 (n = 1534) |
---|---|---|---|
No chronic conditions | 237 (11.5) | 87 (17.7) | 143 (9.3) |
1 chronic condition | 282 (13.6) | 78 (15.9) | 192 (12.5) |
2 chronic conditions | 355 (17.2) | 91 (18.5) | 256 (16.7) |
3 chronic conditions | 332 (16.1) | 59 (12.0) | 270 (17.6) |
4 chronic conditions | 284 (13.7) | 55 (11.2) | 221 (14.4) |
5–9 chronic conditions | 551 (26.6) | 117 (23.8) | 430 (28.0) |
10 + chronic conditions | 27 (1.3) | 5 (1.0) | 22 (1.4) |
Mean ± SD | 3.3 ± 2.4 | 2.9 ± 2.5 | 3.4 ± 2.3 * |
Median | 3 | 2 | 3 |
Range | 0–14 | 0–12 | 0–14 |
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Vallesi, S.; Tuson, M.; Davies, A.; Wood, L. Multimorbidity among People Experiencing Homelessness—Insights from Primary Care Data. Int. J. Environ. Res. Public Health 2021, 18, 6498. https://doi.org/10.3390/ijerph18126498
Vallesi S, Tuson M, Davies A, Wood L. Multimorbidity among People Experiencing Homelessness—Insights from Primary Care Data. International Journal of Environmental Research and Public Health. 2021; 18(12):6498. https://doi.org/10.3390/ijerph18126498
Chicago/Turabian StyleVallesi, Shannen, Matthew Tuson, Andrew Davies, and Lisa Wood. 2021. "Multimorbidity among People Experiencing Homelessness—Insights from Primary Care Data" International Journal of Environmental Research and Public Health 18, no. 12: 6498. https://doi.org/10.3390/ijerph18126498