Article Text
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’.
- public health
- epidemiology
- homelessness
- inequality
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Footnotes
Contributors AS and AH conceived of the initial idea. DL, RWA, DM, CS, PZ, MD, IA, SL, AH and AS contributed to the design of the study. DL conducted data analysis and wrote the first draft of the paper. DL, RWA, DM, CS, PZ, MD, IA, SL, AH and AS contributed to the main content of the manuscript, provided comments on the final draft and approved the manuscript before submission.
Funding DL is funded by an NIHR Doctoral Research Fellowship (DRF-2018-11-ST2- 016). RWA is funded by a Wellcome Trust Clinical Research Career Development Fellowship (206602/Z/17/Z). IA is funded by Sandwell Hospital and Public Health England. SL is funded by an NIHR Clinical Doctoral Research Fellowship (ICA-CDRF-2016-02-042).
Disclaimer Professor Andrew Hayward is a National Institute for Health Research (NIHR) Senior Investigator. The views expressed in this article are those of the author(s) and not necessarily those of theNIHR, or the Department of Health and Social Care.
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.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Data from the survey of homeless people have not been made publicly available because the some individuals may be identifiable. Data from the Health Survey for England used in this study are available via the UK Data Service, serial numbers SN6397, SN6986, SN7260, SN7480, SN7919.
Patient consent for publication Not required.