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Homelessness and he...
Homelessness and health-related outcomes : an umbrella review of observational studies and randomized controlled trials
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- Fornaro, Michele (author)
- Federico Ii Univ Naples, Italy
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- Dragioti, Elena (author)
- Linköpings universitet,Avdelningen för prevention, rehabilitering och nära vård,Medicinska fakulteten,Region Östergötland, Smärt och rehabiliteringscentrum
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- De Prisco, Michele (author)
- Federico Ii Univ Naples, Italy
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- Billeci, Martina (author)
- Federico Ii Univ Naples, Italy
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- Mondin, Anna Maria (author)
- Federico Ii Univ Naples, Italy
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- Calati, Raffaella (author)
- Univ Milano Bicocca, Italy; Nimes Univ Hosp, France
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- Smith, Lee (author)
- Anglia Ruskin Univ, England
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- Hatcher, Simon (author)
- Univ Ottawa, Canada; Ottawa Hosp, Canada; Ottawa Hosp Res Inst, Canada
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- Kaluzienski, Mark (author)
- Univ Ottawa, Canada; Ottawa Hosp, Canada
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- Fiedorowicz, Jess G. (author)
- Univ Ottawa, Canada; Ottawa Hosp, Canada; Ottawa Hosp Res Inst, Canada
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- Solmi, Marco (author)
- Univ Ottawa, Canada; Ottawa Hosp, Canada; Ottawa Hosp Res Inst, Canada; Inst Psychiat Psychol, England; Univ Southampton, England
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- de Bartolomeis, Andrea (author)
- Federico Ii Univ Naples, Italy; Univ Naples Federico II Naples, Italy
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- Carvalho, Andre F. (author)
- Deakin Univ, Australia
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(creator_code:org_t)
- 2022-07-12
- 2022
- English.
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In: BMC Medicine. - : BMC. - 1741-7015. ; 20:1
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https://urn.kb.se/re...
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Abstract
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- Background Homelessness has been associated with multiple detrimental health outcomes across observational studies. However, relatively few randomized controlled trials (RCTs) have been conducted on people who experience homelessness (PEH). Thus, this umbrella review ranked the credibility of evidence derived from systematic reviews (SRs) and meta-analyses (MAs) of observational studies investigating the associations between homelessness and any health outcome as well as RCTs targeting health needs in this population. Methods Several databases were systematically searched from inception through April 28, 2021. Any SR and/or MA reporting quantitative data and providing a control group were eligible for inclusion. The credibility of the evidence derived from observational studies was appraised by considering the significance level of the association and the largest study, the degree of heterogeneity, the presence of small-study effects as well as excess significance bias. The credibility of evidence was then ranked in five classes. For SRs and/or MAs of RCTs, we considered the level of significance and whether the prediction interval crossed the null. The AMSTAR-2 and AMSTAR-plus instruments were adopted to further assess the methodological quality of SRs and/or MAs. The Newcastle-Ottawa Scale (NOS) was employed to further appraise the methodological quality of prospective cohort studies only; a sensitivity analysis limited to higher quality studies was conducted. Results Out of 1549 references, 8 MAs and 2 SRs were included. Among those considering observational studies, 23 unique associations were appraised. Twelve of them were statistically significant at the p <= 0.005 level. Included cases had worst health-related outcomes than controls, but only two associations reached a priori-defined criteria for convincing (class I) evidence namely hospitalization due to any cause among PEH diagnosed with HIV infection, and the occurrence of falls within the past year among PEH. According to the AMSTAR-2 instrument, the methodological quality of all included SRs and/or MAs was "critically low." Interventional studies were scant. Conclusion While homelessness has been repeatedly associated with detrimental health outcomes, only two associations met the criteria for convincing evidence. Furthermore, few RCTs were appraised by SRs and/or MAs. Our umbrella review also highlights the need to standardize definitions of homelessness to be incorporated by forthcoming studies to improve the external validity of the findings in this vulnerable population.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Hälsovetenskap -- Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Health Sciences -- Public Health, Global Health, Social Medicine and Epidemiology (hsv//eng)
Keyword
- Homeless; Health outcomes; Severe mental illness; Umbrella review
Publication and Content Type
- ref (subject category)
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- By the author/editor
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Fornaro, Michele
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Dragioti, Elena
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De Prisco, Miche ...
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Billeci, Martina
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Mondin, Anna Mar ...
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Calati, Raffaell ...
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show more...
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Smith, Lee
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Hatcher, Simon
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Kaluzienski, Mar ...
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Fiedorowicz, Jes ...
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Solmi, Marco
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de Bartolomeis, ...
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Carvalho, Andre ...
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- About the subject
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Health Sciences
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and Public Health Gl ...
- Articles in the publication
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BMC Medicine
- By the university
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Linköping University