MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, 30 Bond St, Toronto, ON, M5B 1W8, Canada.
Applied Health Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Canada.
BMC Public Health. 2020 Mar 30;20(1):419. doi: 10.1186/s12889-020-08499-7.
Dental problems (DPs) and physical chronic diseases (CDs) are highly prevalent and incident in people with low socioeconomic status such as homeless individuals. Yet, evidence on the association between DPs and physical CDs in this population is limited. In the present study, we assessed the association between DPs and type and number of CDs in individuals experienced chronic homelessness and serious mental health problems.
We analyzed cross-sectional baseline data from 575 homeless adults with serious mental health problems participating in the Toronto site of the At Home/Chez Soi randomized controlled trial. Chronic DPs (lasting at least 6 months) were the primary exposure variable. Presence of self-reported CDs, including heart disease, effect of stroke, hypertension, diabetes, asthma, chronic bronchitis/emphysema, stomach or intestinal ulcer, inflammatory bowel disease, migraine, thyroid problems, arthritis, kidney/bladder problems, liver disease (other than hepatitis), and iron-deficiency anemia, were the primary outcomes. The total number of CDs was also analyzed as a secondary outcome. Logistic regression models were used to assess the association between DPs with each of the studied CDs, and negative binomial regression was used to test the association between DPs with the number of CDs.
In our 575 homeless participants (68.5% males) with mean age 40.3 (11.8) years, a high proportion had DPs (42.5%). The presence of DPs was positively associated with heart disease (adjusted odds ratio (AOR):4.19,1.67-10.52), diabetes (AOR:2.17,1.13-4.17), chronic bronchitis (AOR:2.34,1.28-4.29), stomach or intestinal ulcer (AOR:3.48,1.80-6.73), inflammatory bowel disease (AOR:2.52,1.38-4.60), migraine (AOR:1.80,1.20-2.72), arthritis (AOR:2.71,1.71-4.29), kidney/bladder problems (AOR:2.43,1.30-4.54), and iron-deficiency anemia (AOR:3.28,1.90-5.65). DPs were also associated with a higher number of CDs (IRR: 1.62,1.38-1.90).
Dental health problems in homeless individuals with serious mental disorders are associated with several CDs. Dental care should be better integrated into existing social and health programs serving this population to improve their overall health status. The AH/CS study is registered with the International Standard Randomized Control Trial Number Register (ISRCTN42520374).
在社会经济地位较低的人群中，如无家可归者，口腔问题（DPs）和身体慢性疾病（CDs）的发病率很高。然而，关于无家可归者中 DPs 和身体 CDs 之间关联的证据有限。在本研究中，我们评估了经历慢性无家可归和严重精神健康问题的个体中 DPs 与 CDs 类型和数量之间的关联。
我们分析了参加多伦多地区 At Home/Chez Soi 随机对照试验的 575 名严重精神健康问题的无家可归成年人的横断面基线数据。慢性 DPs（持续至少 6 个月）是主要暴露变量。自我报告的 CDs 的存在，包括心脏病、中风影响、高血压、糖尿病、哮喘、慢性支气管炎/肺气肿、胃溃疡/十二指肠溃疡、炎症性肠病、偏头痛、甲状腺问题、关节炎、肾脏/膀胱问题、肝病（除肝炎外）和缺铁性贫血是主要结局。CDs 的数量也作为次要结局进行分析。使用逻辑回归模型评估 DPs 与每项研究的 CDs 之间的关联，使用负二项回归测试 DPs 与 CDs 数量之间的关联。
在我们的 575 名无家可归参与者（68.5%为男性）中，平均年龄为 40.3（11.8）岁，其中很大一部分人患有 DPs（42.5%）。DPs 的存在与心脏病（调整后的优势比（AOR）：4.19，1.67-10.52）、糖尿病（AOR：2.17，1.13-4.17）、慢性支气管炎（AOR：2.34，1.28-4.29）、胃溃疡/十二指肠溃疡（AOR：3.48，1.80-6.73）、炎症性肠病（AOR：2.52，1.38-4.60）、偏头痛（AOR：1.80，1.20-2.72）、关节炎（AOR：2.71，1.71-4.29）、肾脏/膀胱问题（AOR：2.43，1.30-4.54）和缺铁性贫血（AOR：3.28，1.90-5.65）相关。DPs 也与更多的 CDs 数量相关（IRR：1.62，1.38-1.90）。
患有严重精神障碍的无家可归者的口腔健康问题与多种 CDs 有关。应更好地将牙科护理纳入为该人群提供的现有社会和卫生计划中，以提高他们的整体健康状况。AH/CS 研究在国际标准随机对照试验注册中心（ISRCTN42520374）注册。
