Richards Jessica, Kuhn Randall
Department of Community Health Sciences, Jonathan and Karin Fielding School of Public Health, University of California Los Angeles, Los Angeles, California.
AJPM Focus. 2022 Oct 29;2(1):100043. doi: 10.1016/j.focus.2022.100043. eCollection 2023 Mar.
In recent years, cities across the world have seen widespread growth in unsheltered homelessness, in which a person sleeps in a place not meant for human habitation such as cars, parks, sidewalks, and abandoned buildings. It is widely understood that people experiencing homelessness have poorer health outcomes than the general population. Less is known about the health of people who are unsheltered, yet they may be exposed to greater health risks than their sheltered counterparts. The purpose of this literature review is to evaluate and summarize the evidence on unsheltered homelessness and health.
A literature search was conducted using PubMed to identify publications on unsheltered homelessness and health. A total of 42 studies were included for review.
Unsheltered populations experience higher rates of chronic disease, serious mental illness, and substance abuse than sheltered populations. Unsheltered homelessness is strongly associated with chronic homelessness that exacerbates serious mental illness and substance use, which is often co-occurring. Despite having large unmet health needs, unsheltered populations have lower healthcare utilization and often lack health insurance.
Evaluating the impact of shelter status on health outcomes has important implications for the allocation of housing and health services. Longitudinal studies are needed to examine the relationship between the duration of sheltered and unsheltered homelessness and health outcomes and explore the mediating mechanisms that lead to poor health among unsheltered populations. Despite these limitations, our results also suggest an urgent need to address the unique and severe challenges facing unsheltered populations and the need for intervention approaches that are sensitive to these unique disease burdens.
近年来，世界各地的城市中，无家可归者露宿街头的现象普遍增多，这些人睡在诸如汽车、公园、人行道和废弃建筑物等非人类居住的地方。人们普遍认为，无家可归者的健康状况比普通人群更差。对于露宿街头者的健康状况了解较少，但他们可能比有住所的无家可归者面临更大的健康风险。本综述的目的是评估和总结关于露宿街头与健康的证据。
使用PubMed进行文献检索，以确定关于露宿街头与健康的出版物。共纳入42项研究进行综述。
露宿街头的人群比有住所的人群患慢性病、严重精神疾病和药物滥用的比例更高。露宿街头与慢性无家可归密切相关，慢性无家可归会加剧严重精神疾病和药物使用，且这两种情况往往同时出现。尽管有大量未满足的健康需求，但露宿街头的人群医疗利用率较低，且往往缺乏医疗保险。
评估住所状况对健康结果的影响对于住房和医疗服务的分配具有重要意义。需要进行纵向研究，以考察有住所和无住所的无家可归持续时间与健康结果之间的关系，并探索导致露宿街头人群健康状况不佳的中介机制。尽管存在这些局限性，但我们的结果也表明迫切需要应对露宿街头人群面临的独特而严峻的挑战，以及需要采用对这些独特疾病负担敏感的干预方法。
