Original Articles
Identification of Cardiovascular Risk Factors in Homeless Adults

https://doi.org/10.1097/00000441-200211000-00002Get rights and content

ABSTRACT

Background

Cardiovascular disease is an important health problem among homeless adults; however, the common cardiac risk factors present in this population are unknown. This study was undertaken to identify the reversible cardiovascular risks present in the homeless.

Methods

A retrospective chart review was performed randomly on 100 patients who were seen at a homeless clinic in New Orleans, Louisiana. These patients were compared with 200 matched nonhomeless patients who attended an inner-city primary care clinic. Each chart from the 2 groups was reviewed for the presence of hypertension, diabetes mellitus type 2, cigarette smoking, and hypercholesterolemia. Statistical comparisons were made between the homeless and the control subjects.

Results

Hypertension was present in 65% of the homeless but only 52% of the nonhomeless [P < 0.05; odds ratio 1.78 (CI, 1.09 to 2.9)]. Smoking was far more common in the homeless than the nonhomeless, 75 versus 57%, respectively [P < 0.005; odds ratio 2.22 (CI, 1.27 to 3.88)]. There was no difference in the prevalence of diabetes or total cholesterol. Compared with national data hypertension, smoking and diabetes seem to be represented excessively in the homeless population.

Conclusions

Smoking and hypertension are significantly more prevalent in the homeless population than in a matched cohort. Educational and preventive programs are needed to reduce the prevalence of cardiovascular disease and reduce the overutilization of expensive healthcare resources.

Section snippets

Methods

A retrospective chart review was performed after approval was received from the Institutional Review Board. One hundred patients, approximately 10% of all patients seen by the medical service in January 1998 and April 1999 at the Healthcare for the Homeless clinic in New Orleans, were randomly selected. These 2 months were chosen in an attempt to avoid any seasonal bias. Patients were age-, gender-, and race-matched to 200 nonhomeless patients attending an inner city primary care clinic. Twice

Results

We reviewed 300 charts, 100 from the Healthcare for the Homeless clinic and 200 from a primary care clinic. The demographics of the 2 populations are shown in Table 1. As can be seen, age, gender, and ethnicity were well matched.

Of the 4 reversible cardiac risk factors surveyed (Table 2), the prevalence of smoking and hypertension were greater in the homeless. Hypertension was present in 65% of the homeless but only 52% of the nonhomeless [P < 0.05; odds ratio 1.78 (CI, 1.09 to 2.9)]. Smoking

Discussion

The National Coalition for the Homeless estimates that more than 700,000 people experience homelessness every night and more than 2 million people experience homelessness every year. In a survey conducted by Link et al, 11 the 5-year (1985–1990) prevalence of true homelessness was estimated to be 5.7 million people. In New Orleans, 5000 people are believed to be homeless. 12 These numbers are vast underestimates of the true magnitude of the problem because efforts to count the homeless are

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