文章基本信息

标题：Homelessness, Health Status, and Health Care Use
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作者：Bella Schanzer ; Boanerges Dominguez ; Patrick E. Shrout 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2007
卷号：97
期号：3
页码：464-469
DOI：10.2105/AJPH.2005.076190
语种：English
出版社：American Public Health Association
摘要：Objectives. Little is known about the health status of those who are newly homeless. We sought to describe the health status and health care use of new clients of homeless shelters and observe changes in these health indicators over the study period. Methods. We conducted a longitudinal study of 445 individuals from their entry into the homeless shelter system through the subsequent 18 months. Results. Disease was prevalent in the newly homeless. This population accessed health care services at high rates in the year before becoming homeless. Significant improvements in health status were seen over the study period as well as a significant increase in the number who were insured. Conclusion. Newly homeless persons struggle under the combined burdens of residential instability and significant levels of physical disease and mental illness, but many experience some improvements in their health status and access to care during their time in the homeless shelter system. Health problems associated with homelessness are documented throughout the literature. Increased rates of infectious diseases as well as chronic medical conditions have been reported, ranging from community-acquired pneumonia, tuberculosis, and HIV to cardiovascular disease and chronic obstructive lung disease. 1 ^– 7 For some cancer risk factors, prevalence rates are higher in the homeless than in the general population, including sun exposure, cigarette smoking, and alcoholism. 8 Nearly 40% of homeless individuals are reported to have some type of chronic health problem. 9 Psychotic and affective disorders are common, with prevalence rates ranging for the former between 10% and 13% and for the latter between 20% and 40%. 10 ^, 11 Individuals lacking stable housing are more likely to use the emergency department as their regular source of care. 12 In one study, homeless individuals made 20% to 30% of all adult emergency department visits. 13 Homeless patients are admitted to inpatient units 5 times more often and have average lengths of stay that are longer than those of nonhomeless persons. 14 ^, 15 Homelessness is also associated with a foreshortened lifespan. 16 ^, 17 A similar literature exists relating poor health status to lower socioeconomic level 18 ^– 21 as well as racial and ethnic categories. 22 The relation has been reported for dental care, 23 cancer screening, 24 life expectancy, 25 the effect of smoking on health, 26 mortality rates after elective surgery, 27 and many other aspects of physical health and health outcomes. A similar relation has been documented between lower socioeconomic status and poorer mental health. 28 ^– 30 The literature highlights the effect that socioeconomic status has on health status, regardless of housing status. Given the additional stress of homelessness, we questioned whether homelessness would further negatively affect health status and use of the health care system. A few studies have followed homeless individuals longitudinally. These studies confirmed the potentially negative effect homelessness can have on mortality, physical health, mental well-being, and substance use. 31 ^– 36 However, these studies focused on either chronically homeless persons or those living on the street, with the studies beginning after the participants were already homeless. We investigated the effect of being homeless on individuals who were new to homelessness and whether their course—finding housing or remaining homeless—made a difference. In addition, we focused on homeless shelter residents, whose experience of homelessness was most likely different from that of homeless persons living on the street. We chose to study newly homeless individuals from their entry into the New York City homeless shelter system until 18 months later to examine the effect of the longitudinal course of homelessness on health status and health care use. Our data describe health changes that occur over the course of early homelessness experienced in shelters.