Abstract P660: Correlates of Cardiovascular Health Among Unhoused Individuals in a Southeastern City: A Pragmatic Measurement

Abstract

Background: Individuals experiencing homelessness have higher rates of cardiovascular disease than housed populations. Understanding cardiovascular health among unhoused individuals could inform health promoting programming and policies; however, this population is often difficult to reach and understudied. Methods: We partnered with Homeward—a regional coordinating agency for homelessness services—to assess cardiovascular health (CVH) via their semi-annual point-in-time (PIT) count. The PIT is a census of individuals experiencing homelessness in shelters and on the streets within the regional catchment on a pre-designated night. Trained staff administered a 10-minute electronic survey, which captured demographic information and cardiovascular health domains modeled after the American Heart Association’s “Life’s Essential 8”. Considering limited time and context, we used a pragmatic approach to define four behavioral health factors (sleep, food insecurity, physical activity, and smoking) and four self-reported health conditions (overweight/obesity, prediabetes/diabetes, high blood pressure, and high cholesterol). Each component earned 1 point for positive attributes (e.g., adequate sleep) or 0 for negative attributes (e.g., having high blood pressure). Components were summed to a score with a range of 0-8. We also assessed stress to create a broader measure ranging from 0-9 (with low stress earning an additional point). We performed a multivariable linear regression to understand correlates of cardiovascular health among individuals experiencing homelessness. Results: The PIT included 336 unhoused individuals currently sleeping in shelters or outdoors. The mean score for the 8-point measurement was 4.74 (SD=1.62), and the mean score for the 9-point measurement was 5.03 (SD=1.78). Neither the 8- nor 9-point score differed by gender, education, veteran status, length of homelessness, where the individual slept the night prior to the PIT count, or eviction history. In the adjusted model, increasing age was associated with a half point decrease in CVH score (β=-0.49; p =0.006). White unhoused respondents demonstrated a lower CVH score compared to Black respondents (β =-0.579; p =0.03) adjusting for other factors. Day laborers and part-time workers demonstrated approximately 1-point higher CVH scores (β =1.01; p=0.03; β =0.88; p=0.033, respectively) than unemployed individuals. Conclusion: Age, race, and employment status demonstrated associations with ideal cardiovascular health in this population of unhoused individuals in the southeastern US. Preliminary findings suggest that employment might be a target for cardiovascular health improvement among unhoused individuals.