Background
Methods
Literature searches
Study inclusion and exclusion criteria
Data extraction strategy
Risk of bias assessment
Data synthesis and presentation
Results
First author | Publication year | Year of data collection | Country | Study design | Source population | Sample analysed | Type of homelessness | Problem-drinkers % in the sample | Ethnicity | Gender M% | Age years mean (range) |
---|---|---|---|---|---|---|---|---|---|---|---|
Figueroa | 1953 | 1949 | USA | Survey | Alcoholic homeless men in a Chicago prison | 24 | Rough sleepers | 100% | 8.3% Black | 100% | 45 (20–60+) |
Darnton-Hill | 1986 | 1981–86 | Australia | Survey | Men from two Sydney hostels and one clinic for homeless | 39a
| Hostel | 70% | NR | 100% | 51.5 (26–76) |
van der Westhuyzen | 1987 | NR | South Africa | Comparative survey | Men from 24 homeless hostels in Pretoria | 49 | Hostel | 100% | Black | 100% | 38 (22–65) |
Drijver | 1993 | NR | Netherlands | Intervention study | Rotterdam homeless houses | 10 | Hostel | 100% | NR | 90% | 48 (38–64) |
Kertesz | 2001 | 1998 | USA | Case report | NR | 2 | Rough sleepers | 100% | one black person, other NR | 100% | (55–58) |
Malmauret | 2002 | 1999–2000 | France | Survey | Adult rough sleepers in Paris | 71 | Rough sleepers | 84% | NR | 88.5% | 48 (26–76) |
Fung | 2005 | NR | Australia | Case report | A homeless person seeking medical help | 1 | Rough sleeper | 100% | NR | 100% | 44 |
Kubisova | 2008 | 2003 | Czech Republic | Survey | homeless people on streets in Prague | 201 | Rough sleepers; hostel | Likely > 50% | NR | 87% M | 41 (19–70) |
Lee | 2014 | 2013 | South Korea | Retrospective survey | homeless visiting emergency department | 217 | NR | 100% | NR | 96% M | 51 (44–56) |
Risk of bias in included studies
Data synthesis
Deficiencies reported
Author/Year | Deficiency/measure reported | Definition of deficiency | Technique used to measure |
---|---|---|---|
Figueroa 1953 [17] | Fasting Hour Excretion of B1 and B2 | B1 = < 0.6 microgram./hr; B2 = 20 μ/hr | Photofluorometery: B1 = Hennesey and Cerecedo’s technique; B2 = Connor and Straub’s method. |
Darnton-Hill 1986 [13] | TPP effect and TK activity for B1; blood levels of: B6; B9; B12; C; albumin a | TPP effect for B1= > 14% activity; TK activity for B1 = < 130 μmol/min/L; B6 = < 300 μmol/min/L;P5P for B6= > 50% activity; B12 = <150pmol/L; Iron = <10 μmol/L; C = < 23 μmol/L; serum B9 = <4 ng/ml | B1 = measuring colorimetrically the formation of sedoheptulose-7-phosphate with ribose-5- phosphate as the substrate; B6 = erythrocyte transaminase and pryidoxal5 phosphate activation. B9 and B12 = isotopic radioassay; C = colorimetric procedure using dinitrophenylhydrazine. |
van der Westhuyzen 1987 [22] | Blood levels of: B6; B9; B12; albumin; erythrocyte level of B1 | Reference ranges determined in healthy subjects: B6 = 26–96 nmol/; B1 = 50–106 microgram/liter; B12 = 160–900 ng/l; serum folate = 2–13microgram/liter; serum I'-glutamyltransferase (GGT) = 10–50 U/I. | Radio-assay kit; Biochromatic Analyzer commercial kits; For B1 = automated microbiological assay using a streptomycin-resistant mutant of Lactobacillus fermenci as the test organism. |
Drijver 1993 [16] | TDP effect and TK activity for B1; Blood levels of: B6; B12 | TDP effect reference range = 0–25%; TK activity reference range = 10.4–15.1 U/mmol Hb; PLP effect reference range = 35–107 nmol/l; | HPLC; PLP measured with a fluorimeter |
Kertesz 2001 [24] | Levels NR. Results of the following were found normal: B12; B 9; iron | NR | Hospital tests |
Malmauret 2002 [21] | Blood levels of vitamins: A; B1; B6; B9; B12; C; E | B6 = 23–100 nmol/l; B12 = 160–420 pmol/l; B1 = 6–40 mmol/l. | HPLC and radioimmunoassay |
Fung 2005 [23] | Anaemia, albumin level | NR | NR |
Kubisova 2008 [18] | Blood levels of: prealbumin; albumin; haemoglobin | Albumin <33 g/l; prealbumin <0.16 g/l. | NR |
Lee 2014 [20] | Blood levels of: B1; B6; B12; C; haemoglobin | Reference ranges for vitamins: B1 = 59 to 213; B12 = 200 to 950; B6 = 20 to 202; C = 26.1 to 84.6 | Vitamin B1, B6, and C = HPLC; B12 levels = electro-chemiluminescence immunoassay |
Evidence on deficiencies- Prevalence and severity
Study | Number | Deficient proportion (%) of the participants | Deficiency levels - Mean ± SD (range) | ||||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
B1 | B 2 | B6 | B9 | B12 | C | A | E | Hb | Albumin | B1 | B 2 μ/hr | B6 | B9 | B12 | C μmol/L | A μmol/L | E μmol/L | Hb g/dL | Albumin g/L | ||
Figueroa 1953 [17] | 24 | 0 | 18 | . | . | . | . | . | . | 9.2 | . | 2.9 μ/hr | 70 | . | . | . | . | . | . | 15.2 | . |
Darnton-Hill 1986 [13] | 39 | 45 | . | 20 | 31 | 0 | 29 | . | . | . | 26 | TPP 15.3 ± 10.5 | . | P5P57.0 ± 26.6 | 3.6 ± 4.0 ng/ml | 341 ± 203 ng/ml | 34.9 ± 16.2 | . | . | . | . |
van der Westhuyzen 1987 [22] | 49 | 51.2 | . | 7.3 | 4.1 | 0 | . | . | . | . | 0 | 51.5 ± 11.0 μg/L | . | 61.9 ± 25.1 nmol/L | 4.3 ± 1.8 (R 1.0–9.0) ng/ml | 0.648 ± 0.235 ng/ml | . | . | . | . | 38.9 ± 2.5 |
Drijver 1993 [16] | 10 | . | . | . | . | . | . | . | . | . | . | TDP 18 | . | PLP 34.2 nmol/L | . | TK 9.6 μ/mmolHb | . | . | . | . | . |
Kertesz 2001 [24] | 1 | . | . | . | . | . | . | . | . | . | . | . | . | . | . | . | . | . | . | . | 35 ± 2.5 |
Malmauret 2002 [21] | 71 | 5.6 | . | 5.6 | 0 | 14.1 | 95 | 43.6 | 19.7 | . | . | 58 ± 104 μmol/L | . | 152 ± 143 nmol/L | 12.7 ± 7.3 nmol/L | 385 ± 225 pmol/L | 16 ± 8 | 1.88 ± 0.95 | 22 ± 7 | . | . |
Fung 2005 [23] | 1 | . | . | . | . | . | . | . | . | 100 | . | . | . | . | . | . | . | 10.8 | 28 | ||
Kubisova 2008 [18] | 201 | . | . | . | . | . | . | . | . | . | 2 | . | . | . | . | . | . | 14 ± 0.1 (M); 12.1 ± 0.2 (F) | 42 ± 4 | ||
Lee 2014 [20] | 217 | 2.3 | . | 23.5 | . | 2.3 | 84.3 | . | . | . | . | 145.8 (108.5–197.7) nmol/L | . | 34.2 (20.5–65.45) nmol/L | . | 0.617 (0.458–0.918) ng/ml | 11.60 (3.65–21.55) | . | . | 14 IQR (12.4–15.3) | . |