Table 2.
Evidence from SRs or MAs of observational studies for the association between homelessness and any health outcome
| Criteria for Level-of-Evidence Classification | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Author, year | Adverse health outcomes | Exposed/unexposed | Prevalence (%) based on cohort studies | No. of included studies per association | Random-effects measure, ES (95% CIs) | Results | p value random effects | I2 (p value) | PIs (95 % CIs) | SSE/ESB | LS | CE | AMSTAR-2 quality |
| Aidala et al., 2016 [223] | Hospitalization due to any cause | PEH with HIV/Non-homeless with HIV | 21.8% | 4 | OR: 2.05 (1.7–2.46) | Increased odds for PEH with HIV | 4.6×10−15 | 4.5% (0.85) | 1.31–3.19 | No/no | Yes | I | Critically low |
| Suh et al., 2020 [217] | Falls in the previous year | PEH/Non-homeless | NA | 3 | RR: 3.42 (3.15–3.70) | Increased chances for PEH | 1.07×10−199 | 0.08% (0.969) | 2.03–5.73 | No/No | Yes | I | Critically low |
| Aldridge et al., 2017 | Mortality due to any cause | PEH/General population | NA | 5 | SMR: 6.22 (4.2–9.2) | Increased chances for PEH | 6.8×10−20 | 98.16% (0.0001) | 1.53–25.33 | No/NA | Yes | II | Critically low |
| Aldridge et al., 2017 | Mortality due to external causes, as defined by ICD-10 | PEH/General population | NA | 6 | SMR: 15.75 (10.58–23.44) | Increased chances for PEH | 5.2×10−42 | 97.43% (0.0001) | 3.63–68.17) | No/NA | Yes | II | Critically low |
| Arum et al., 2021 [216] | HCV infection | PEH who inject drugs/PEH who did not inject drugs | NA | 19 | RR: 1.66 (1.37−2) | Increased chances for PEH who inject drugs | 1.4×10−7 | 55.4% (0.0019) | 0.88–3.12 | No/NA | Yes | II | Critically low |
| Suh et al., 2020 [217] | Limitations in activities of daily living | PEH/Non-homeless | NA | 4 | RR: 1.46 (1.27–1.68) | Increased chances for PEH | 8.7×10−8 | 53.2% (0.057) | 0.85–2.49 | No/No | Yes | II | Critically low |
| Suh et al., 2020 [217] | Limitations in instrumental activities of daily living | PEH/Non-homeless | NA | 4 | RR: 1.36 (1.25–1.48) | Increased chances for PEH | 7.4×10−13 | 44.9% (0.199) | 0.99–1.85 | No/No | Yes | II | Critically low |
| Aidala et al., 2016 [223] | Emergency department use due to any cause | PEH with HIV/Non-homeless with HIV | 21.6% | 6 | OR: 1.73 (1.31–2.28) | Increased chances for PEH with HIV | 1×10−4 | 67.2% (0.22) | 0.75–3.97 | No/No | Yes | III | Critically low |
| Aidala et al., 2016 [223] | Nonadherence to antiretroviral therapy | PEH/Non-homeless | 8.5% | 5 | OR: 1.55 (1.29–1.86) | Increased chances for PEH | 2.3×10−6 | 16.5% (0.689) | 1.04–2.31 | No/Yes | Yes | III | Critically low |
| Al-Shakarchi et al., 2020 [218] | Diagnosis of cardiovascular disease, as defined by ICD-10 | PEH/Non-homeless | 26.8% | 9 | OR: 2.59 (1.61–4.18) | Increased chances for PEH | 9.6×10−5 | 98.4% (0.0001) | 0.44–15.23 | No/NA | Yes | III | Critically low |
| Arum et al., 2021 [216] | HIV infection | PEH who inject drugs/PEH who did not inject drugs | NA | 12 | RR: 1.43 (1.12–1.83) | Increased chances for PEH who inject drugs | 0.0037 | 52.9% (0.015) | 0.72–2.85 | No/NA | Yes | III | Critically low |
| van Draanen et al., 2020 [219] | Opioid-related overdose | PEH/Non-homeless | NA | 4 | OR: 2.10 (1.43–3.10) | Increased chances for PEH | 1.5×10−4 | 59.8% (0.032) | 0.45–9.75 | No/NP | Yes | III | Critically low |
| Bassuk et al., 2015 [222] | Mental Health problems, assessed by the Child Behavior Checklist | Homeless schoolchildren/non-homeless school children | NA | 3 | OR: 1.77 (1.13–2.76) | Increased chances for Homeless school children | 0.012 | 17.9% (0.518) | 0.05–64.4 | No/NP | Yes | IV | Critically low |
| Lin et al., 2019 [220] | Adherence to antiretroviral therapy | PEH/General population | NA | 4 | OR: 0.5 (0.32–0.77) | Better adherence in the general population | 0.002 | 72.4% (0.064) | 0.08–3.16 | No/No | Yes | IV | Critically low |
| Suh et al., 2020 [217] | Frailty | PEH/Non-homeless | NA | 3 | RR: 2.59 (1.05–6.39) | Increased chances for PEH | 0.0388 | 97.8% (0.0001) | 0.001–2.8×105 | Yes/NA | Yes | IV | Critically low |
| Tweed et al., 2021 [215] | Mortality due to external causes, as defined in ICD-10 | PEH with SUD/PEH without SUD | NA | 4 | HR: 2.3 (1.26–4.2) | Increased chances for PEH with SUD | 0.0069 | 78.5% (0.093) | 0.17–31.02 | No/NA | Yes | IV | Critically low |
| Aidala et al., 2016 [223] | Mortality due to any cause | PEH with HIV/Non-homeless with HIV | 32.8% | 7 | HR: 1.43 (0.74–2.77) | Increased chances for PEH with HIV | 0.286 | 90.5% (0.001) | 0.15–13.69 | No/No | Yes | NS | Critically low |
| Aidala et al., 2016 [223] | Viral load non-suppression | PEH with HIV/Non-homeless with HIV | 5.6% | 3 | OR: 1.23 (0.89–1.71) | Increased chances for PEH with HIV | 0.215 | 70% (0.083) | 0.03–51.48 | No/No | No | NS | Critically low |
| Bassuk et al., 2015 [222] | Mental Health problems, assessed by the Child Behavior Checklist | Homeless pre-school children/non-homeless pre-school children | 4.6% | 3 | OR: 1.47 (0.93–2.35) | Increased chances for Homeless pre-school children | 0.101 | 13.9% (0.544) | 0.04–53.39 | No/NP | Yes | NS | Critically low |
| Bassuk et al., 2015 [222] | Mental Health problems, assessed by the Child Depression Inventory | Homeless school children/non-homeless school children | NA | 3 | OR: 1.45 (0.77–2.73) | Increased chances for Homeless school children | 0.248 | 31.6% (0.35) | 0.01–453.76 | No/NP | No | NS | Critically low |
| Tweed et al., 2021 [215] | Mortality due to any cause | PEH with SUD/PEH without SUD | 45.5% | 5 | HR: 1.6 (0.99–2.57) | Increased chances for PEH with SUD | 0.0536 | 96.1% (1×10−4) | 0.26–9.61 | No/No | Yes | NS | Critically low |
| Tweed et al., 2021 [215] | Mortality due to any cause | PEH with SMI/PEH without SMI | 8.4% | 3 | HR: 0.89 (0.69–1.15) | Increased chances for PEH without SMI | 0.382 | 19.9% (0.473) | 0.1–7.64 | No/NP | No | NS | Critically low |
| Tweed et al., 2021 [215] | Mortality due to external causes, as defined by ICD-10 | PEH with SMI/Homeless without SMI | NA | 3 | HR: 3.13 (0.78–12.51) | Increased chances for PEH with SMI | 0.106 | 93.4% (0.003) | 0.001–9.6×107 | No/NA | Yes | NS | Critically low |
CE credibility evidence, CI confidence interval, ES effect size, ESB excess significance bias, HR hazard ratio, ICD-10 International Classification of Diseases, 10th revision, LS largest study with significant effect, MA meta-analysis, NA not applicable, NP not pertinent because of fewer than expected number of observed studies, NS not significant, OR odds ratio, PEH people experiencing homelessness, PI prediction interval, RR risk ratio, SMI severe mental illness, SMR standardized mortality ratio, SR systematic review, SSE small study effect, SUD substance use disorder