The health of homeless people in high-income countries: descriptive epidemiology, health consequences, and clinical and policy recommendations.
The health of homeless people in high-income countries: descriptive epidemiology, health consequences, and clinical and policy recommendations.
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DOI：
10.1016/s0140-6736(14)61132-6
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发表时间：
2014-10-25
期刊：
影响因子：
--
通讯作者：
Kushel M
中科院分区：
文献类型：
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作者：
Fazel S;Geddes JR;Kushel M
在欧盟，任何一个晚上都有超过40万人无家可归，而在美国，有超过60万人无家可归。无家可归的原因是个人因素和结构性因素之间的相互作用。个人因素包括贫困、家庭问题、精神健康和药物滥用问题。低成本住房的可获得性被认为是无家可归的最重要的结构性决定因素。与其他人口相比，无家可归者的过早死亡率更高，特别是自杀和意外伤害，以及一系列传染病、精神障碍和药物滥用的患病率增加。非传染性疾病的高发病率也被描述为加速老龄化的证据。尽管与医疗服务的接触和对治疗的坚持往往会受到影响，但无家可归者通常比非无家可归者更常去急诊科就诊。我们讨论了几项建议，以改善对无家可归者发病率和死亡率的监测。以高危群体为重点的方案，如离开监狱、精神病院和儿童福利系统的个人，以及针对无家可归者的国家和全州计划的引入，可能会改善结果。
In the European Union, more than 400 000 individuals are homeless on any one night and more than 600 000 are homeless in the USA. The causes of homelessness are an interaction between individual and structural factors. Individual factors include poverty, family problems, and mental health and substance misuse problems. The availability of low-cost housing is thought to be the most important structural determinant for homelessness. Homeless people have higher rates of premature mortality than the rest of the population, especially from suicide and unintentional injuries, and an increased prevalence of a range of infectious diseases, mental disorders, and substance misuse. High rates of non-communicable diseases have also been described with evidence of accelerated ageing. Although engagement with health services and adherence to treatments is often compromised, homeless people typically attend the emergency department more often than non-homeless people. We discuss several recommendations to improve the surveillance of morbidity and mortality in homeless people. Programmes focused on high-risk groups, such as individuals leaving prisons, psychiatric hospitals, and the child welfare system, and the introduction of national and state-wide plans that target homeless people are likely to improve outcomes.