Dear Editor,
We have read with interest the HOPE HOME Study by Garcia-Grossman et al.1 that evaluates factors associated with incarceration in homeless older adults and found that both individual and structural risk factors cause high prevalence of incarceration. In the HOPE HOME Study, the early (age < 50) and late (age > 50) onset of homeless individuals is approximately equal.1 Although the onset of homelessness did not contribute to the incarceration in the present study, from the imprisonment problem, pathways to late-onset homelessness is known that these individuals are more likely to have housing hampered by one-time charges (i.e., one drug charge) than early-onset homelessness.2 We can speculate that drug use may be more “globally disruptive” across life domains, interfering not only with one’s financial stability but also with one’s social functioning and physical and mental health.2 From three states (Arizona, Florida, and Washington)’ hospital claim data analysis, homeless individuals 60 years and older were more likely to be hospitalized with hard drugs (i.e., cocaine and heroin) by 5 or 6 times in comparison with non-homeless individuals with ages of 60 and older.3 In the same analysis, African American homeless individuals are associated with 2.75 times higher risk of cocaine-related hospitalizations compared to White homeless individuals.3 Although there is no significant difference of marijuana use between African Americans and White, African Americans are 3 times more likely to be arrested by marijuana-related crimes between 2001 and 2014 compared to Whites.4 This racial disparity can be interpreted as structural racism in the criminal justice system.4 Obviously, health is the by-product of social justice. African American homeless individuals, the majority of the HOPE HOME Study participants, are vulnerable to depletion of health and social justice due to structural racism. The economic costs of structural racism are too high to ignore. To resolve this urgent matter from healthcare systems and communities, now it is time to embrace antiracist changes by developing training curriculum about social justice and homeless individuals for healthcare providers, especially, those working for safety net healthcare systems and communities.
Declarations
Conflict of Interest
The authors declare that they do not have a conflict of interest
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References
- 1.Garcia-Grossman I, Kaplan L, Valle K, Guzman D, Williams B, Kushel M. Factors associated with incarceration in older adults experiencing homelessness: results from the HOPE HOME Study. J Gen Intern Med. 2022:37(5):1088-1096. [DOI] [PMC free article] [PubMed]
- 2.Brown RT, Goodman L, Guzman D, Tieu L, Ponath C, Kushel MB. Pathways to homelessness among older homeless adults: results from the HOPE HOME Study. PLoS ONE. 2016;11(5):e0155065. [DOI] [PMC free article] [PubMed]
- 3.Chun SY, Yoo JW, Park H, et al. Trends and age-related characteristics of substance use in the hospitalized homeless population. Medicine (Baltimore). 2022;101(8):e28917. [DOI] [PMC free article] [PubMed]
- 4.Matthew DB. Just Health: Treating Structural Racism to Heal America. New York University Press; New York, NY. 2022.