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Disparities in Diabetes Processes of Care in People Experiencing Homelessness
TAKE-HOME MESSAGE
- This population-based propensity matched cohort study compared the processes of diabetes care by homeless status. Homelessness was associated with fewer tests for HbA1c, LDL-C, serum creatinine, and urine protein quantification and eye examinations. Patients with a history of homelessness were less likely to use primary care or specialist care for diabetes management.
- There is significant disparity in diabetes care in people with a history of homelessness, which is contributing towards excess morbidity. Further interventions targeting this patient population is needed to improve diabetes care and prevent long-term complications.
abstract
This abstract is available on the publisher's site.
Access this abstract now Full Text Available for ClinicalKey SubscribersAIMS
To compare processes of diabetes care by homeless status.
METHODS
A population-based propensity matched cohort study was conducted in Ontario, Canada. People with diabetes were identified in administrative healthcare data between April 2006 and March 2019. Those with a documented history of homelessness were matched to non-homeless controls. Data on processes of care measures included glucose monitoring tests, screening for microvascular complications, and physician follow-up. Differences in processes of care were compared by homeless status using proportions, risk ratios, and rate ratios.
RESULTS
Of the 1,076,437 people with diabetes, 5219 matched pairs were identified. Homelessness was associated with fewer tests for glycated hemoglobin (RR = 0.63; 95 %CI: 0.60-0.67), LDL cholesterol (RR = 0.80; 95 %CI: 0.78-0.82), serum creatinine (RR = 0.94; 95 %CI: 0.92-0.97), urine protein quantification (RR = 0.62; 95 %CI: 0.59-0.66), and eye examinations (RR = 0.74; 95 %CI: 0.71-0.77). People with a history of homelessness were less likely to use primary care for diabetes management (RR = 0.62; 95 %CI: 0.59-0.66) or specialist care (RR = 0.87; 95 %CI: 0.83-0.91) compared to non-homeless controls.
CONCLUSIONS
Disparities in diabetes care are evident for people with a history of homelessness and contribute to excess morbidity in this population. These data provide an impetus for investment in tailored interventions to improve healthcare equity and prevent long-term complications.
Additional Info
Disparities in diabetes processes of care among people experiencing homelessness: An opportunity for intervention
Diabetes Res. Clin. Pract. 2024 Jun 15;213(xx)111748, K Wiens, L Bai, SW Hwang, PE Ronksley, PC Austin, GL Booth, E Spackman, DJT CampbellFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Research has highlighted many areas where inequalities in diabetes care exist, including social class, gender, sex, and ethnicity. Homeless individuals are particularly at risk, with research identifying unique challenges to care such as inadequate nutrition, limited healthcare access, and increased prevalence of comorbidities.1
Complementing the research that exists on mechanisms by which disparities occur within diabetes care for individuals who are homeless, Wiens et al present a compelling view of the impact of homelessness on diabetes care against guidelines in Ontario, Canada. Using a matched-pairs design, the authors highlight the disparities in contact with primary and specialist diabetes services as well as regular screening and monitoring in individuals with a history of homelessness compared with those without.
This study was carried out in Canada; however, these findings have relevance more widely. For example, work in the UK has reported that over 270,000 people meet the definition of homelessness, which includes those living in supported or temporary accommodation as well as those sleeping rough.2
The research from Wiens et al supports the need for tailored interventions that address the unique challenges that this group encounter and the importance of regular contact with medical professionals and appropriate screening.
References