Abstract
BackgroundDental problems (DPs) and physical chronic diseases (CDs) are highly prevalent and incident in people with low socioeconomic status such as homeless individuals. Yet, evidence on the association between DPs and physical CDs in this population is limited. In the present study, we assessed the association between DPs and type and number of CDs in individuals experienced chronic homelessness and serious mental health problems.MethodsWe analyzed cross-sectional baseline data from 575 homeless adults with serious mental health problems participating in the Toronto site of the At Home/Chez Soi randomized controlled trial. Chronic DPs (lasting at least 6 months) were the primary exposure variable. Presence of self-reported CDs, including heart disease, effect of stroke, hypertension, diabetes, asthma, chronic bronchitis/emphysema, stomach or intestinal ulcer, inflammatory bowel disease, migraine, thyroid problems, arthritis, kidney/bladder problems, liver disease (other than hepatitis), and iron-deficiency anemia, were the primary outcomes. The total number of CDs was also analyzed as a secondary outcome.Logistic regression models were used to assess the association between DPs with each of the studied CDs, and negative binomial regression was used to test the association between DPs with the number of CDs.ResultsIn our 575 homeless participants (68.5% males) with mean age 40.3 (11.8) years, a high proportion had DPs (42.5%). The presence of DPs was positively associated with heart disease (adjusted odds ratio (AOR):4.19,1.67–10.52), diabetes (AOR:2.17,1.13–4.17), chronic bronchitis (AOR:2.34,1.28–4.29), stomach or intestinal ulcer (AOR:3.48,1.80–6.73), inflammatory bowel disease (AOR:2.52,1.38–4.60), migraine (AOR:1.80,1.20–2.72), arthritis (AOR:2.71,1.71–4.29), kidney/bladder problems (AOR:2.43,1.30–4.54), and iron-deficiency anemia (AOR:3.28,1.90–5.65). DPs were also associated with a higher number of CDs (IRR: 1.62,1.38–1.90).ConclusionDental health problems in homeless individuals with serious mental disorders are associated with several CDs. Dental care should be better integrated into existing social and health programs serving this population to improve their overall health status.The AH/CS study is registered with the International Standard Randomized Control Trial Number Register (ISRCTN42520374).
Highlights
Dental problems (DPs) and physical chronic diseases (CDs) are highly prevalent and incident in people with low socioeconomic status such as homeless individuals
DPs vary by socioeconomic position (SEP) with those with lower incomes or education [3] or individuals who have no fixed address having more DPs and other poor health conditions such as physical chronic diseases (CDs) [1, 4, 5]
The present study, carried out within the Canadian socioeconomic and health system context, seeks to investigate the following research questions: (1) Is there an association between dental health problems and selected CDs in homeless people living with serious mental illness? (2) Is the number of CDs higher among those reporting chronic DPs compared with those not reporting chronic DPs?
Summary
Dental problems (DPs) and physical chronic diseases (CDs) are highly prevalent and incident in people with low socioeconomic status such as homeless individuals. DPs vary by socioeconomic position (SEP) with those with lower incomes or education [3] or individuals who have no fixed address having more DPs and other poor health conditions such as physical chronic diseases (CDs) [1, 4, 5]. DPs have been found to be associated with various CDs, including cardiovascular diseases (CVD) [6,7,8], metabolic syndrome [9], diabetes [10], lung [11] and kidney problems [12] in the general population. Several risk factors have been found to be associated with both DPs and CDs, including smoking, alcohol use, and having an unhealthy diet [1, 13]. Much of the existing literature on DPs and CDs has been conducted in the general population rather than in groups of lower SEP or individuals who are precariously housed
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