Prevalence, incidence, and outcomes across cardiovascular diseases in homeless individuals- a case-control study using national linked electronic health records

Abstract

Abstract Background Homelessness is increasing globally. The risk and burden of cardiovascular disease (CVD) are higher in homeless than in housed individuals but the population-based analyses, required for planning of effective interventions and policies, are lacking. Purpose Using national electronic health records (EHRs), we investigated prevalence, incidence and outcomes across a range of CVDs among homeless individuals. Methods Using linked UK primary care EHR and validated phenotypes, we identified homeless individuals aged ≥16 years between 1998 and 2019, and age- and sex-matched housed controls in a 1:5 ratio. For twelve CVDs (stable angina; unstable angina; myocardial infarction; sudden cardiac death or cardiac arrest; unheralded coronary death; heart failure; transient ischaemic attack; ischaemic stroke or stroke not further specified; subarachnoid haemorrhage; intracerebral haemorrhage; peripheral arterial disease; abdominal aortic aneurysm), we estimated prevalence, incidence and 1-year mortality risks, comparing homeless and housed groups. Results We identified 8492 homeless individuals and 32134 matched controls. Comorbidities and risk factors were more prevalent in the homeless group, e.g. smoking: 78.1% vs 48.3% and atrial fibrillation: 9.9% vs 8.6%, p<0.001. CVD prevalence (11.6% and 6.5%), incidence (e.g. incidence rate ratio, 3.36, 1.99–5.66 and 2.18, 1.50–3.16 in men and women, respectively, aged <35 years), and 1-year mortality risk were higher (adjusted hazard ratio 2.30, 1.70–3.12), and onset was earlier (difference: 4.6, 2.8–6.3 years, p<0.001), in homeless, compared with housed people. Other than cerebrovascular and peripheral vascular diseases in women (where numbers of events were small), homeless individuals had higher incidence of CVD in all three arterial territories than housed people. Conclusions CVD in homeless individuals has high prevalence, incidence and 1-year mortality risk with early onset, and high burden of risk factors. Health and social care strategies in inclusion health should reflect this high burden of treatable risk factors and disease. Incidence of CVD in homeless individuals Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): National Institute of Health Research