Chest
Volume 125, Issue 5, May 2004, Pages 1719-1725
Journal home page for Chest

Clinical Investigations
COPD
Obstructive Lung Disease Among the Urban Homeless

https://doi.org/10.1378/chest.125.5.1719Get rights and content

Study objectives

Homelessness is a growing problem in the United States that may significantly impair physical health. The homeless have a high prevalence of cigarette smoking, poor nutrition, and adverse environmental exposures, which could contribute to obstructive lung disease (OLD). Despite this risk, the prevalence of OLD among the homeless remains unknown. We aimed to systematically assess the prevalence of OLD among the urban homeless.

Design, setting, and participants

We conducted a cross-sectional study of the prevalence of OLD among homeless individuals in San Francisco. By random sampling, we recruited 68 adults living in one homeless shelter to participate in a structured interview survey and spirometry assessment. We used a multifaceted approach to assess OLD, including respiratory symptoms, self-reported physician diagnosis of asthma, chronic bronchitis, emphysema, or COPD, and spirometry (defined as FEV1 < 80% predicted and FEV1/FVC ratio < 0.70).

Results

Sixty-eight adults completed the survey, and 67 adults completed the spirometry. Homeless adults were likely to be homeless < 1 year and homeless for the first time. There was a high prevalence of cigarette smoking (75% ever smokers, 68% current smokers). The prevalence of symptoms suggestive of OLD was high, including cough (29%), wheezing (40%), chronic bronchitis symptoms (21%), and dyspnea on exertion (29%). A substantial proportion of homeless subjects indicated a prior diagnosis of asthma (24%), chronic bronchitis (19%), and COPD (4%). Based on spirometry, the prevalence of OLD was 15% (95% confidence interval, 8 to 26%), which was more than double the expected prevalence in the general US population.

Conclusions

As OLD is a leading cause of death in the United States, it is important to identify it early for treatment. Homeless individuals have a higher-than-expected prevalence of OLD. Public health interventions should target the homeless population for prevention and treatment of OLD.

Section snippets

Overview

We conducted a cross-sectional examination of the prevalence of OLD in a random sample of homeless individuals in San Francisco. This was a field study with direct personal interviews and spirometry conducted with homeless individuals.

Study Participants and Recruitment

We recruited a random sample of homeless adults aged ≥ 35 years to participate. We used the Stewart B. McKinney Homeless Assistance Act of 1987 definition to determine those who were currently homeless.22 As all subjects were current residents of one homeless

Results

Sociodemographic variables were different for the homeless subjects compared to the general population of San Francisco (Table 1). Subjects ranged in age from 35 to 73 years, with mean age of 46.5 years and a slight male predominance (62%). Compared to the San Francisco general population, minorities were overrepresented. African-Americans represented 50% of the total, white represented 16%, and Latino represented 12%. Use of cigarettes, tobacco pipes, and cigars was common among the homeless

Discussion

The burden of OLD in the United States is substantial, including disability, mortality, and economic costs.32 As one of the leading causes of death in the United States, OLD has been underreported and undertreated.28333435 Previous studies3637 established that patients with OLD have a higher incidence of morbidity with respiratory infections, leading to higher health-care utilization. In a study of medical conditions in the homeless, pulmonary disease, primarily OLD, conferred a higher risk of

ACKNOWLEDGMENT

We thank Dr. Jacqueline Tulsky, Dr. Sharad Jain, Douglas Jenny, the staff and residents at Multi-Service Center South in San Francisco, and the project interviewers: Marina Goldovsky, Jen Johnson, Sarah Kemble, Jongping Lu, Michele Montandon, and Scott Young.

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    Dr. Eisner was supported by K23 HL04201 from the National Heart, Lung, and Blood Institute.

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