背景:无家可归是一个复杂的社会和公共卫生挑战。关于有无家可归经历(PEH)的人的人口水平健康和社会护理相关预测因素以及后果的信息有限。专注于人口亚组或临时问卷调查以收集数据的研究对于整个人口健康监测和规划的适用性相对有限。这项研究的目的是寻找和综合有关危险因素的信息,以及后果,在使用常规管理数据的全人群研究中经历无家可归。
方法:我们使用EMBASE进行了系统搜索,MEDLINE,Cochrane图书馆,从开始到2023年2月发表的用于英语研究的护理和联合健康文献(CINAHL)和PsycINFO研究数据库的累积指数,报告了有关无家可归,健康和社会护理相关预测因素和后果的行政数据分析。我们遵循系统评价和荟萃分析(PRISMA)指南的首选报告项目。
结果:在所审查的1224篇文章中,30份出版物符合纳入标准。纳入的研究考察了广泛的主题领域,每个人使用的无家可归定义都有很大差异。研究分为几个主题领域:死亡率,发病率和COVID-19;医疗保健使用和重新入院;养老院入住和收容所;以及其他(例如就业,犯罪受害)。研究报告说,无家可归的人的身心健康状况比普通人群差。无家可归的人更有可能有更高的住院风险,更有可能使用急诊室,与一般人群相比,死亡率更高,需要重症监护或死于COVID-19的风险更高。此外,无家可归的人更有可能被监禁或失业。与那些在以后的生活中经历过无家可归的人相比,对那些小时候无家可归的人的影响最大。
结论:这是对全人群观察性研究的首次系统评价,该研究使用行政数据来确定与无家可归个体相关的原因和后果。虽然科学文献提供了一些与无家可归相关的可能风险因素的证据,对这一研究课题的研究有限,差距仍然存在。需要更标准化的最佳实践方法,以更好地了解与无家可归相关的原因和后果。
Homelessness is a complex societal and public health challenge. Limited information exists about the population-level health and social care-related predictors and consequences of persons with lived experience of homelessness (PEH). Studies that focus on population subgroups or ad hoc questionnaires to gather data are of relatively limited generalisability to whole-population health surveillance and planning. The aim of this study was to find and synthesise information about the risk factors for, and consequences of, experiencing homelessness in whole-population studies that used routine administrative data.
We performed a systematic search using EMBASE, MEDLINE, the Cochrane Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and PsycINFO research databases for English-language studies published from inception until February 2023 that reported analyses of administrative data about homelessness and health and social care-related predictors and consequences. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
Of the 1224 articles reviewed, 30 publications met the inclusion criteria. The included studies examined a wide range of topic areas, and the homelessness definitions used in each varied considerably. Studies were categorised into several topic areas: Mortality, morbidity and COVID-19; health care usage and hospital re-admission; care home admission and shelter stay; and other (e.g. employment, crime victimisation). The studies reported that that the physical and mental health of people who experience homelessness was worse than that of the general population. Homeless individuals were more likely to have higher risk of hospitalisation, more likely to use emergency departments, have higher mortality rates and were at greater risk of needing intensive care or of dying from COVID-19 compared with general population. Additionally, homeless individuals were more likely to be incarcerated or unemployed. The effects were strongest for those who experienced being homeless as a child compared to those who experienced being homeless later on in life.
This is the first systematic
review of whole-population observational studies that used administrative data to identify causes and consequences associated with individuals who are experiencing homelessness. While the scientific literature provides evidence on some of the possible risk factors associated with being homeless, research into this research topic has been limited and gaps still remain. There is a need for more standardised best practice approaches to understand better the causes and consequences associated with being homeless.