The Hotel Study: Multimorbidity in a Community Sample Living in Marginal Housing
The Hotel Study: Multimorbidity in a Community Sample Living in Marginal Housing
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DOI：
10.1176/appi.ajp.2013.12111439
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发表时间：
2013-12-01
影响因子：
17.7
通讯作者：
Honer, William G.
中科院分区：
文献类型：
--
作者：
Vila-Rodriguez, Fidel;Panenka, William J.;Honer, William G.
目的：生活在边缘住房的人的健康状况没有很好地表征，特别是从多重疾病的角度来看。作者在一个社区样本中调查了这一人群。方法：前瞻性社区样本（N=293）居住在单人房酒店的成年人，随访时间中位数为23.7个月。评估包括精神病学和神经学评估、多模态磁共振成像和病毒检测。结果：66.6%的参与者描述了之前的无家可归。在552人年的随访期间，有15人死亡。标准化死亡率为4.83 （95% CI=2.91 ~ 8.01）。药物依赖普遍存在（95.2%），注射吸毒占61.7%。精神病是最常见的精神疾病（47.4%）。45.8%的参与者存在神经系统疾病，28.0%的参与者有明确的MRI发现。18.4%的参与者HIV血清学阳性，70.3%的参与者丙型肝炎病毒血清学阳性。多重疾病的中位数（从12个列表中）是3个。多重疾病负担与较低的角色功能评分显著相关。共病成瘾或身体疾病显著降低了治疗精神病的可能性，但没有降低治疗阿片类药物依赖或艾滋病毒疾病的可能性。在随访期间死亡的参与者似乎具有与总体样本相似的多病概况。结论：这一边缘性群体的死亡率高于预期，多病发生率高，与角色功能和精神病治疗可能性存在不良关联。这些发现可以指导在边缘住房环境中有效的卫生保健服务的发展。
Objective: The health of people living in marginal housing is not well characterized, particularly from the perspective of multi-morbid illness. The authors investigated this population in a community sample.Method: A prospective community sample (N=293) of adults living in single-room occupancy hotels was followed for a median of 23.7 months. Assessment included psychiatric and neurological evaluation, multimodal M RI, and viral testing.Results: Previous homelessness was described in 66.6% of participants. Fifteen deaths occurred during 552 person-years of follow-up. The standardized mortality ratio was 4.83 (95% CI=2.91-8.01). Substance dependence was ubiquitous (95.2%), with 61.7% injection drug use. Psychosis was the most common mental illness (47.4%). A neurological disorder was present in 45.8% of participants, with definite MRI findings in 28.0%. HIV serology was positive in 18.4% of participants, and hepatitis C virus serology in 70.3%. The median number of multimorbid illnesses (from a list of 12) was three. Burden of multimorbidity was significantly correlated with lower role functioning score. Comorbid addiction or physical illness significantly decreased the likelihood of treatment for psychosis but not the likelihood of treatment for opioid dependence or HIV disease. Participants who died during follow-up appeared to have profiles of multimorbidity similar to those of the overall sample.Conclusions: This marginally housed cohort had greater than expected mortality and high levels of multimorbidity with adverse associations with role function and likelihood of treatment for psychosis. These findings may guide the development of effective health care delivery in the setting of marginal housing.