Chronic diseases and multi-morbidity in persons experiencing homelessness: results from a cross-sectional study conducted at three humanitarian clinics in Germany in 2020

Abstract

Background Persons experiencing homelessness (PEH) suffer a high burden of chronic diseases and multi-morbidity, yet face significant barriers in accessing healthcare services. These health inequalities were further aggravated during the COVID-19 pandemic. While there is a lack of comprehensive health data on PEH, even less is known about populations experiencing housing exclusion, a hidden form of homelessness. This study examines and compares chronic diseases and multi-morbidity in PEH, persons experiencing housing exclusion, and persons with secure housing who lacked access to regular healthcare services in the wake of the COVID-19 pandemic in Germany. Methods Study participants were adults who sought medical care at clinics of the humanitarian organisation “Ärzte der Welt” in Munich, Hamburg and Berlin in 2020. The patients were categorised into three housing groups according to the ETHOS classification of homelessness and housing exclusion. Socio-demographic characteristics, self-rated health, chronic diseases and multi-morbidity were described in each group. Logistic regression analysis was used to identify socio-demographic factors associated with higher odds of chronic diseases and multi-morbidity in each housing group. Results Of the 695 study participants, 333 experienced homelessness, 292 experienced housing exclusion and 70 had secure housing. 92.3% of all patients had either no or limited health coverage, and 96.7% were below the poverty line. Males and EU/EEA citizens were highly represented among PEH (74.2% and 56.8% respectively). PEH had lower self-rated health (47.8%, p = 0.04), and a higher prevalence of psychiatric illness (20.9%, p = 0.04). In adjusted analyses, belonging to the age group 35–49 and ≥ 50 years were associated with greater odds of chronic disease (AOR = 2.33, 95% CI = 1.68–3.24; AOR = 3.57, 95% CI = 2.55–5.01, respectively) while being ≥ 50 years old was associated with multi-morbidity (AOR = 2.01, 95% CI = 1.21, 3.33). Of the 18 participants tested for SARS-COV-2, 15 were PEH, 1 of whom tested positive. Conclusions Housing status was not an independent risk factor for chronic disease and multi-morbidity in our study population. However, PEH reported poorer self-rated and psychiatric health. Strategies to improve access to healthcare services amongst persons experiencing homelessness and housing exclusion are needed in Germany.

Burden of long COVID among adults experiencing sheltered homelessness: a longitudinal cohort study in King County, WA between September 2020—April 2022

“…Our study suggests that long COVID may exacerbate existing challenges that PEH face in health and wellbeing [ 48 – 50 ]. Persistent COVID-19 symptoms impacted participants’ key activities such as employment, ability to care for themselves and others, and access to homelessness services.…”

Morbidity and mortality in a prospective cohort of people who were homeless during the COVID-19 pandemic

“…This may have facilitated the spread of the virus (8). In addition to these environmental risk factors, people who are homeless are known to have a high prevalence of chronic diseases, particularly lung disease, addictions, and are predominantly male and aging, which are known risk factors for severe forms of COVID-19 (9)(10)(11).…”

“…In particular, previous studies showed that the spread of COVID-19 was greater in the population experiencing homelessness than in the general population, with seroprevalence rates ranging from 4 to 36%, depending on where they were living at the time of the screening/diagnosis (i.e., rates at least 3-4 times higher than in the general population) (12)(13)(14)(15)(16)(17)(18)(19)(20). Nonetheless, few studies have investigated the consequences of the COVID-19 pandemic on the health status of people experiencing homelessness, either in terms of morbidity or mortality (9,(21)(22)(23)(24). Most of these studies have limited their design to a cross-sectional approach, with the results mainly related to the first wave of the pandemic (from March to August 2020).…”