Background
Methods
Search strategy
Eligibility criteria
Data extraction
Data analysis and assessment of the credibility of evidence
Results
Author, year (type of study) | Type of studies included | Health outcome examined | Exposures/active treatment | Control group | No. of studies included in the MA or SR (No. of studies included in the present UR) | Population | Homelessness adopted definition | AMSTAR-2 or AMSTAR-plus |
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Tweed et al., 2021 (MA) [215] | Cross-sectional, case-control, cohort studies, and baseline data from interventional studies | Mortality, morbidity, health-related quality of life, self-rated health | Homelessness, imprisonment, substance use (other than alcohol, cannabis, or performance-enhancing drugs), sex working, SMI | Absence of homelessness, imprisonment, substance use, sex working, or SMI | 237 (5) | People experiencing homelessness, imprisonment, substance use, sex working, or SMI | People who are rough sleeping or unstably/marginally housed | Critically low |
Arum et al., 2021 (MA) [216] | Cross-sectional, case-control, cohort studies | HIV and HCV diagnosis | Homelessness, unstable housing | Absence of homelessness or unstable housing | 37 (24) | People who use injective drugs | Lacking access to adequate housing, according to the Institute of Global Homelessness | Critically low |
Suh et al., 2020 (MA) [217] | Cross-sectional, cohort studies | Geriatric syndrome outcomes | Homelessness | Absence of homelessness | 5 (4) | People experiencing homelessness | People lacking a fixed, regular, and adequate nighttime residence, including those utilizing temporary shelters, being homeless, living in an abandoned building or vehicle, or any other unstable or nonpermanent situation, according to the US Department of Health and Human Services | Critically low |
Al-Shakarchi et al., 2020 (MA) [218] | Case-control, cohort studies | Cardiovascular disease | Homelessness | Absence of homelessness | 17 (9) | People experiencing homelessness | Not provided | Critically low |
van Draanen et al., 2020 (SR) [219] | Cross-sectional, case-control, cohort studies | Opioid-related fatal and non-fatal overdose | Any measure of socioeconomic marginalization | Different levels of socio-economic marginalization | 37 (4) | People who use opioids in North America, Europe, the United Kingdom, Australia, and New Zealand | Not provided | Critically low |
Lin et al., 2019 (MA) [220] | Cross-sectional, cohort studies | Antiretroviral therapy adherence | Homelessness, sex working, or drug use | Absence of homelessness, sex working, or drug use | 29 (4) | People with HIV infection | Not provided | Critically low |
Aldridge et al., 2017 (MA) | SRs, MAs, cross-sectional, cohort studies | Mortality, morbidity | Homelessness, imprisonment, sex working, substance use disorder | Absence of homelessness, imprisonment, sex working, or substance use disorder | 337 (3) | People experiencing homelessness, imprisonment, substance use, or sex working | Not provided | Critically low |
Bassuk et al., 2015 (MA) [222] | Cross-sectional, case-control, cohort studies | Mental health disorders, behavioral disorders | Homelessness | Absence of homelessness | 7 (7) | Children/adolescents experiencing homelessness aged less than 18 years, enrolled in the United States and accompanied by a parent | The literal definition of homelessness includes emergency shelter, transitional housing, residing in places not meant for human habitation, fleeing domestic violence, or not having an identified residence | Critically low |
Aidala et al. 2016 (SR) [223] | Cross-sectional, case-control, cohort studies, RCT | HIV health care access and utilization, adherence to antiretroviral treatments, HIV clinical health outcomes, other health outcomes, emergency department, and inpatient use, HIV risk behaviors | Homelessness, unstable housing | Absence of homelessness or unstable housing | 152 (19) | People with HIV infection who live in high-income countries | Not provided | Critically low |
Hyun et al., 2020 (MA) [224] | RCT, cluster RCT | Depression, anxiety, mental health status, PTSD symptoms, psychological distress, self-efficacy, quality of life | Psychosocial interventions | Control condition | 11 (6) | People experiencing homelessness | Living situation of rooflessness without a shelter of any kind and houselessness with a temporary institution or shelter to sleep, according to the European typology on homelessness and housing exclusion | 10 |
Description and summary of associations
Observational studies
Criteria for Level-of-Evidence Classification | |||||||||||||
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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 |
Intervention studies
Author, year | Considered health outcome | Active treatment/control treatment | Number of patients allocated to each treatment | No. of included studies per association | Random-effects measure, ES (95% CIs) | Results | p value random effects | I2 (p value) | PIs (95 % CIs) | LS | AMSTAR-plus |
---|---|---|---|---|---|---|---|---|---|---|---|
Hyun et al., 2020 [224] | Depression | Psychological interventions/treatment as usual | 236/224 | 5 | SMD: − 0.24 (− 0.49–0.02) | Psychological interventions are more effectiver than treatment as usual | 0.07 | 42.6% (0.2) | − 0.964–0.491 | No | 10 |
Hyun et al., 2020 [224] | Anxiety | Psychological interventions/treatment as usual | 229/215 | 5 | SMD: − 0.25 (− 0.51–0) | Psychological interventions are moe effective than treatment as usual | 0.05 | 39.9% (0.28) | − 0.967–0.459 | No | 10 |