Cardiovascular disease in homeless versus housed individuals: a systematic review of observational and interventional studies. Issue 19 (14th July 2020)

• Record Type: Journal Article
• Authors: Al-Shakarchi, Nader James; Evans, Hannah; Luchenski, Serena A; Story, Alistair; Banerjee, Amitava
• Is Part Of: Heart. Volume 106:Issue 19(2020)
• Page Start: 1483
• Page End: 1488
• Publication Date: 2020-07-14
• Subjects: health care delivery -- quality and outcomes of care -- global healthcare delivery; Heart -- Diseases -- Treatment -- Periodicals; Cardiology -- Periodicals; 616.12
• DOI: 10.1136/heartjnl-2020-316706
• Languages: English
• ISSNs: 1355-6037

Abstract

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; I 2 =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; I 2 =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.