Non-communicable Disease among Homeless Men in Nagoya, Japan: Relationship between Metabolic Abnormalities and Sociodemographic Backgrounds

Abstract

Objective To examine the degree of metabolic abnormalities and their association with the sociodemographic background or mental illness/cognitive disability among homeless men in Nagoya, Japan. Methods We interviewed 106 homeless men (aged 54.2±12.7 years) and measured their metabolic parameters. Mental illness and cognitive disability were diagnosed using the Mini-International Neuropsychiatric Interview and Wechsler Adult Intelligence Scale-III test, respectively. Associations between metabolic abnormalities and the sociodemographic background or mental illness/cognitive disability were analyzed. Results There were significant correlations of liver dysfunction (AST! 35 IU, ALT! 35 IU, γ-GTP! 75 IU), hypertension [systolic/diastolic blood pressure (BP) ! 140/90 mmHg], and dyslipidemia (HDL <40 mg/dL) with the history/duration of homelessness (over 2 times/year) and residence status (living on the streets). Although the mean body mass index (BMI), BP, HbA1c, and LDL in participants living in temporary residences were similar to those obtained from the general population data from National Health Nutrition Survey (NHNS) 2016, the systolic/diastolic BP in those living on the street was significantly higher than in the general population, and the HDL in those living in temporary residences was significantly lower than in those reported in the NHNS 2016 data. In the group with cognitive disability, the ALT, TG, and BMI values were significantly higher and the HDL level significantly lower in those living in temporary residences than in those living on the streets. Conclusion Stressful conditions while living on the streets may exacerbate hypertension and liver dysfunction, and unhealthy food habits when living in a temporary residence may exacerbate low HDL levels. In addition, an inability to self-manage due to cognitive disability may increase the ALT, TG, and BMI values. The provision of homeless people with the skills to sustain independent living conditions and ensure a healthy diet is required.

Markedly poor physical functioning status of people experiencing homelessness admitted to an acute hospital setting

“…Notably high was the number of participants in this study cohort who suffered from hepatitis (41.5%) which is approaching levels of 50.0% reported in a cohort of homeless men residing in Los Angeles 53 . It is likely that commonly reported medical conditions among people who are homeless such as headaches/migraines, hypertension and arthritis 54 were under-reported among our study sample perhaps due to a lack of self-disclosure or diagnostic overshadowing. Respiratory problems 55 were also likely under-reported especially as 80.0% of the cohort were current smokers which is comparable to rates over 70.0% quoted in community based homeless samples 50 , 56 .…”