Mortality Among Homeless Adults in Boston

Baggett, Travis P.; Hwang, Stephen W.; O’Connell, James J.; Porneala, Bianca; Stringfellow, Erin; Orav, E. John; Singer, Daniel E.; Rigotti, Nancy A.

doi:10.1001/jamainternmed.2013.1604

Cited by 438 publications

(290 citation statements)

References 34 publications

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“…These data may suggest that intervening to facilitate smoking cessation among the homeless (even unsuccessfully) might be a catalyst for a reduction in non-nicotine substance use as well. Such interventions may be especially critical given recent evidence that drug use has replaced HIV as the leading cause of mortality among homeless individuals in at least one area of the country (30). …”

Section: Discussionmentioning

confidence: 99%

Is smoking cessation associated with worse comorbid substance use outcomes among homeless adults?

et al. 2014

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Background and Aims Smoking prevalence among homeless adults is exceedingly high, and high rates of comorbid substance use are among the barriers to abstinence experienced by this group. The extent to which smoking cessation might engender an escalation in comorbid substance use could be a concern prohibiting treatment provision and engagement. This study examined whether smoking abstinence status was associated with alcohol and substance use at 26 weeks post-randomization among homeless smokers in a smoking cessation trial. Design The current study was a secondary analysis of randomized smoking cessation intervention trial data. Setting The parent study was conducted in the Minneapolis/St. Paul area of Minnesota, USA. Participants Participants were 427 homeless adult smokers interested in quitting smoking. Measurements Covariates collected at baseline included alcohol, cocaine, marijuana/hashish, heroin, and “any” drug use, age, sex, race/ethnicity, education, tobacco dependence, length of time homeless, and treatment group. Biochemically-verified smoking abstinence and self-reported alcohol and substance use were collected at 26 weeks post-randomization. Findings Smoking abstinence was associated with fewer drinking days (p=.03), fewer drinks consumed on drinking days (p=.01), and lower odds of heavy drinking (p=.05), but not with differences in the number of days of cocaine, marijuana/hashish, heroin, or any drug use. Conclusions In homeless smokers, achieving smoking abstinence may be associated with a reduction in alcohol consumption but appears not to be associated with a substantial change in other drug use.

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Section: Discussionmentioning

confidence: 99%

Is smoking cessation associated with worse comorbid substance use outcomes among homeless adults?

et al. 2014

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“…5 In addition, other common reasons for seeking health care include environmental insults such as injuries, insect bites, and complications from heat and cold exposure. All contribute to significant premature mortality in this population, 6–10 with an average estimated life expectancy of 42 to 52 years for chronically homeless individuals. 11 Factors contributing to the health problems of homeless people include extreme poverty, inadequate access to health care, nonadherence to therapy, and the adverse health effects of homelessness itself.…”

mentioning

confidence: 99%

“…Among the homeless population, cardiovascular disease has been identified as the second leading cause of death, after injuries or overdoses. 6 …”

mentioning

confidence: 99%

Diabetes and Hypertension Prevalence in Homeless Adults in the United States: A Systematic Review and Meta-Analysis

et al. 2015

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We estimated hypertension and diabetes prevalence among US homeless adults compared with the general population, and investigated prevalence trends. We systematically searched 5 databases for published studies (1980–2014) that included hypertension or diabetes prevalence for US homeless adults, pooled disease prevalence, and explored heterogeneity sources. We used the National Health Interview Survey for comparison. We included data from 97 366 homeless adults. The pooled prevalence of self-reported hypertension was 27.0% (95% confidence interval = 23.8%, 29.9%; n = 43 studies) and of diabetes was 8.0% (95% confidence interval = 6.8%, 9.2%; n = 39 studies). We found no difference in hypertension or diabetes prevalence between the homeless and general population. Additional health care and housing resources are needed to meet the significant, growing burden of chronic disease in the homeless population.

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“…8,9 The literature has highlighted the cumulative and continued impact of these risk factors even when homeless individuals achieve housing. 7,10,11 Diabetes mellitus is one example of a chronic medical condition where unmet healthcare needs may impact health outcomes. Type 2 diabetes affects nearly 26 million people in the United States, or 8.3 % of the U.S. population.…”

Section: Introductionmentioning

confidence: 99%

Differential Impact of Homelessness on Glycemic Control in Veterans with Type 2 Diabetes Mellitus

et al. 2016

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BACKGROUND: Veterans with evidence of homelessness have high rates of mental health and substance abuse disorders, but chronic medical conditions such as diabetes are also prevalent. OBJECTIVE: We aimed to determine the impact of homelessness on glycemic control in patients with type 2 diabetes mellitus. DESIGN: Longitudinal analysis of a retrospective cohort. SUBJECTS: A national cohort of 1,263,906 Veterans with type 2 diabetes. Subjects with evidence of homelessness were identified using a combination of diagnostic and administrative codes. MAIN MEASURES: Odds for poor glycemic control using hemoglobin A1C (HbA1C) cutoff values of 8 % and 9 %. Homeless defined as a score based on the number of indicator variables for homelessness within a veterans chart. KEY RESULTS: Veterans with evidence of homelessness had a significantly greater annual mean HbA1C ≥ 8 (32.6 % vs. 20.43 %) and HbA1C ≥ 9 (21.4 % vs. 9.9 %), tended to be younger (58 vs. 67 years), were more likely to be non-Hispanic black (39.1 %), divorced (43 %) or never married (34 %), to be urban dwelling (88.8 %), and to have comorbid substance abuse (46.7 %), depression (42.3 %), psychoses (39.7 %), liver disease (18.8 %), and fluid/ electrolyte disorders (20.4 %), relative to non-homeless veterans (all p < 0.0001). Homelessness was modeled as an ordinal variable that scored the number of times a homelessness indicator was found in the Veterans medical record. We observed a significant interaction between homelessness and race/ethnicity on the odds of poor glycemic control. Homelessness, across all racial-ethnic groups, was associated with increased odds of uncontrolled diabetes at a cut-point of 8 % and 9 % for hemoglobin A1C ; however, the magnitude of the association was greater in non-Hispanic whites [8 %, OR 1.55 (1.47;1.63 CONCLUSIONS: Homelessness is a significant risk factor for uncontrolled diabetes in Veterans, especially among non-Hispanic white and Hispanic patients. While efforts to engage homeless patients in primary care services have had some success in recent years, these data suggest that broader efforts targeting management of diabetes and other chronic medical conditions remain warranted.

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Mortality Among Homeless Adults in Boston

Cited by 438 publications

References 34 publications

Is smoking cessation associated with worse comorbid substance use outcomes among homeless adults?

Is smoking cessation associated with worse comorbid substance use outcomes among homeless adults?

Diabetes and Hypertension Prevalence in Homeless Adults in the United States: A Systematic Review and Meta-Analysis

Differential Impact of Homelessness on Glycemic Control in Veterans with Type 2 Diabetes Mellitus

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