Homelessness and Quality Adjusted Life Years: Slopes and Cliffs in Health Inequalities a cross-sectional survey
Homeless individuals have a disproportionately high burden of morbidity and mortality. There is further marginisalisation of this group because their health disparities are typically not measured in routine health statistics. Addressing this disparity is a key challenge for public health. This study aimed to compare the prevalence of chronic disease across population quintiles of social deprivation and in homeless people, and estimate the Quality Adjusted Life Years (QALY) associated with homelessness.
METHODS:
A cross-sectional survey was conducted at 27 homeless services in London. Survey questions were directly comparable to those within the national Health Survey for England allowing assessment across quintiles of deprivation in the housed and homeless populations. Poisson regression models were used to calculate age and sex adjusted rates of chronic disease. QALYs were measured by EQ5D.
RESULTS:
A response rate of 77% (455/592) was achieved. The majority of respondents were male (365/452; 80.75%) aged 16-44 (261/455; 57.36%) and born in the UK (277/452; 61.28%). After adjusting for age and sex, compared to housed people living in the most socially deprived areas, homeless people had a higher risk of asthma (2.46; 95%CI:1.78-3.39), heart disease (5.87; 95%CI:3.63-9.49), stroke (4.93; 95% CI 2.15-11.28) and epilepsy (12.40; 95% CI 5.10-30.16). QALYs reduced with each quintile of deprivation and after adjusting for age and sex homelessness was associated with an increased risk of a utility less than 0.5 of 8.1 (95% CI 5.79-11.50). It was estimated that compared to a housed population, one year of homeless was associated with a loss of 0.117 QALYs.
CONCLUSIONS:
These data illustrate the substantial burden of disease and QALY loss in the homeless population. The substantial disparity in the health experience of the homeless is more akin to a cliff, with homeless people experiencing a dramatic change in the level of morbidity and QALY loss.