Prevalence, incidence, and outcomes across cardiovascular diseases in homeless individuals using national linked electronic health records
© The Author(s) 2020. Published by Oxford University Press on behalf of the European Society of Cardiology..
AIMS: The risk and burden of cardiovascular disease (CVD) are higher in homeless than in housed individuals but population-based analyses are lacking. The aim of this study was to investigate prevalence, incidence and outcomes across a range of specific CVDs among homeless individuals.
METHODS AND RESULTS: Using linked UK primary care electronic health records (EHRs) and validated phenotypes, we identified homeless individuals aged ≥16 years between 1998 and 2019, and age- and sex-matched housed controls in a 1:5 ratio. For 12 CVDs (stable angina; unstable angina; myocardial infarction; sudden cardiac death or cardiac arrest; unheralded coronary death; heart failure; transient ischaemic attack; ischaemic stroke; subarachnoid haemorrhage; intracerebral haemorrhage; peripheral arterial disease; abdominal aortic aneurysm), we estimated prevalence, incidence, and 1-year mortality post-diagnosis, comparing homeless and housed groups. We identified 8492 homeless individuals (32 134 matched housed individuals). Comorbidities and risk factors were more prevalent in homeless people, e.g. smoking: 78.1% vs. 48.3% and atrial fibrillation: 9.9% vs. 8.6%, P < 0.001. CVD prevalence (11.6% vs. 6.5%), incidence (14.7 vs. 8.1 per 1000 person-years), and 1-year mortality risk [adjusted hazard ratio 1.64, 95% confidence interval (CI) 1.29-2.08, P < 0.001] were higher, and onset was earlier (difference 4.6, 95% CI 2.8-6.3 years, P < 0.001), in homeless, compared with housed people. Homeless individuals had higher CVD incidence in all three arterial territories than housed people.
CONCLUSION: CVD in homeless individuals has high prevalence, incidence, and 1-year mortality risk post-diagnosis with earlier onset, and high burden of risk factors. Inclusion health and social care strategies should reflect this high preventable and treatable burden, which is increasingly important in the current COVID-19 context.
| Errataetall: |
CommentOn: Eur Heart J. 2020 Nov 1;41(41):4037-4046. - PMID 32984892 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2020 |
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| Erschienen: |
2020 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:41 |
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| Enthalten in: |
European heart journal - 41(2020), 41 vom: 01. Nov., Seite 4011-4020 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Nanjo, Atsunori [VerfasserIn] |
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| Links: |
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| Themen: |
Angiotensins |
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| Anmerkungen: |
Date Completed 23.11.2020 Date Revised 01.04.2021 published: Print CommentOn: Eur Heart J. 2020 Nov 1;41(41):4037-4046. - PMID 32984892 Citation Status MEDLINE |
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| doi: |
10.1093/eurheartj/ehaa795 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| 245 | 1 | 0 | |a Prevalence, incidence, and outcomes across cardiovascular diseases in homeless individuals using national linked electronic health records |
| 264 | 1 | |c 2020 | |
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| 500 | |a Date Completed 23.11.2020 | ||
| 500 | |a Date Revised 01.04.2021 | ||
| 500 | |a published: Print | ||
| 500 | |a CommentOn: Eur Heart J. 2020 Nov 1;41(41):4037-4046. - PMID 32984892 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © The Author(s) 2020. Published by Oxford University Press on behalf of the European Society of Cardiology. | ||
| 520 | |a AIMS: The risk and burden of cardiovascular disease (CVD) are higher in homeless than in housed individuals but population-based analyses are lacking. The aim of this study was to investigate prevalence, incidence and outcomes across a range of specific CVDs among homeless individuals | ||
| 520 | |a METHODS AND RESULTS: Using linked UK primary care electronic health records (EHRs) and validated phenotypes, we identified homeless individuals aged ≥16 years between 1998 and 2019, and age- and sex-matched housed controls in a 1:5 ratio. For 12 CVDs (stable angina; unstable angina; myocardial infarction; sudden cardiac death or cardiac arrest; unheralded coronary death; heart failure; transient ischaemic attack; ischaemic stroke; subarachnoid haemorrhage; intracerebral haemorrhage; peripheral arterial disease; abdominal aortic aneurysm), we estimated prevalence, incidence, and 1-year mortality post-diagnosis, comparing homeless and housed groups. We identified 8492 homeless individuals (32 134 matched housed individuals). Comorbidities and risk factors were more prevalent in homeless people, e.g. smoking: 78.1% vs. 48.3% and atrial fibrillation: 9.9% vs. 8.6%, P < 0.001. CVD prevalence (11.6% vs. 6.5%), incidence (14.7 vs. 8.1 per 1000 person-years), and 1-year mortality risk [adjusted hazard ratio 1.64, 95% confidence interval (CI) 1.29-2.08, P < 0.001] were higher, and onset was earlier (difference 4.6, 95% CI 2.8-6.3 years, P < 0.001), in homeless, compared with housed people. Homeless individuals had higher CVD incidence in all three arterial territories than housed people | ||
| 520 | |a CONCLUSION: CVD in homeless individuals has high prevalence, incidence, and 1-year mortality risk post-diagnosis with earlier onset, and high burden of risk factors. Inclusion health and social care strategies should reflect this high preventable and treatable burden, which is increasingly important in the current COVID-19 context | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Comment | |
| 650 | 4 | |a COVID-19 | |
| 650 | 4 | |a Cardiovascular | |
| 650 | 4 | |a Electronic health records | |
| 650 | 4 | |a Health inequalities | |
| 650 | 4 | |a Homeless | |
| 650 | 7 | |a Angiotensins |2 NLM | |
| 700 | 1 | |a Evans, Hannah |e verfasserin |4 aut | |
| 700 | 1 | |a Direk, Kenan |e verfasserin |4 aut | |
| 700 | 1 | |a Hayward, Andrew C |e verfasserin |4 aut | |
| 700 | 1 | |a Story, Alistair |e verfasserin |4 aut | |
| 700 | 1 | |a Banerjee, Amitava |e verfasserin |4 aut | |
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