Characteristics of People with Type I or Type II Diabetes with and without a History of Homelessness: A Population-based Cohort Study

Abstract

Introduction: Homelessness poses unique barriers to diabetes management. Population-level data on the risks of diabetes outcomes among people experiencing homelessness are needed to inform resource investment. The aim of this study was to create a population cohort of people with diabetes with a history of homelessness to understand their unique demographic and clinical characteristics and improve long-term health outcomes. Methods: Ontario residents with diabetes were identified in administrative hospital databases between 2006 and 2020. A history of homelessness was identified using a validated algorithm. Demographic and clinical characteristics were compared between people with and without a history of homelessness. Propensity score matching was used to create a cohort of people with diabetes experiencing homelessness matched to comparable non-homeless controls. Results: Of the 1,455,567 patients with diabetes who used hospital services, 0.7% (n=8,599) had a history of homelessness. Patients with a history of homelessness were younger (mean: 54 vs 66 years), more likely to be male (66% vs 51%) and more likely to live in a large urban centre (25% vs 7%). Notably, they were also more likely to be diagnosed with mental illness (49% vs 2%) and be admitted to a designated inpatient mental health bed (37% versus 1%). A suitable match was found for 5219 (75%) people with documented homelessness. The derived matched cohort was balanced on important demographic and clinical characteristics. Conclusion: People with diabetes experiencing homelessness have unique characteristics that may require additional supports. Population-level comparisons can inform the delivery of tailored diabetes care and self-management resources.

Type 2 diabetes management in the homeless population: health inequality and the Housing First approach

“…1,2 The homeless population is a uniquely vulnerable patient group, facing increased risk of sexual and physical violence, poorer nutritional status, lower medication compliance rates, less dependable wound care, reduced access to healthcare causing delayed presentations, and higher rates of co-morbidities. [3][4][5] As the case study exemplifies, these complexities complicate and hamper T2DM care for homeless individuals. Indeed, it is estimated that the prevalence of T2DM is 33% more common in homeless individuals (8-22%) compared to the UK population-wide prevalence (6%).…”

Group Versus Individual Diabetes Education for Persons With Experience of Homelessness in Canada

“…3 Persons with lived experiences of homelessness (PWLEH) and diabetes in Canada have been found to have more than 20 times the rate of mental health and substance use disorders compared to those with diabetes who have never been homeless, which makes self-management even more challenging. 4 These individuals also have to manage their diabetes while dealing with unstable housing, a lack of healthy food options, and limited access to medications and diabetes supplies. 5-7…”