Skip to main content

Advertisement

SpringerLink
Log in

Racial Differences in Prevalence of Cardiometabolic Morbidities Among Homeless Men

  • Published:
Journal of Racial and Ethnic Health Disparities Aims and scope Submit manuscript

Abstract

Introduction

Homelessness is associated with an increased risk of cardiometabolic morbidities. However, few studies have been performed to evaluate the racial differences on these morbidities commonly seen in the homeless.

Methods

A retrospective chart review was conducted to examine the racial differences in the prevalence of cardiometabolic morbidities among the homeless men served at a local health care screening clinic. Medical information was extracted and collated into a single Excel spreadsheet. Racial differences in cardiometabolic morbidities were evaluated using multivariable binary or ordinal logistic regression analyses, adjusting for age, body mass index, and smoking status.

Results

Of the 551 homeless men, 377 (68.4%) were Black, and 174 (31.6%) were White. The mean age (47.8±11.9 years) of Black homeless men was significantly older than that (45.4±13.0 years) of White homeless men (p=0.03). Blacks were 2.7 (95% CI = 1.75, 4.16) times more likely to be in the less desirable HbA1c categories than Whites. By contrast, Blacks were less likely to have non-desirable lipid profile than Whites. Blacks were 0.42 (95% CI = 0.29, 0.62) times and 0.51 (95% CI = 0.28, 0.94) times likely to be in the non-desirable high-density lipoprotein (HDL) and low-density lipoprotein (LDL) categories than Whites, respectively.

Conclusion

Black homeless men are more likely to have pre-diabetes or diabetes than White counterparts. On the other hand, Black homeless men have better lipid profiles of HDL or LDL than their White counterparts. Our findings reveal the health challenges of the homeless men and can provide guidance on policy changes related to diet and nutrition of meal programs provided by homeless shelters and congregate meal program to address the health disparities by race in this population.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Availability of Data and Material

Yes upon request with following the institutional sharing policy on data and material.

Code Availability

Not applicable

References

  1. Development USDoHaU. 2019 Annual Homelessness Assessment Report: Part 1: point-in-time estimates of homelessness in the U.S. . 2019.

  2. Lee TC, Hanlon JG, Ben-David J, Booth GL, Cantor WJ, Connelly PW, et al. Risk factors for cardiovascular disease in homeless adults. Circulation. 2005;111(20):2629–35.

    Article  Google Scholar 

  3. Macnee CL, Hemphill JC, Letran J. Screening clinics for the homeless: evaluating outcomes. J Community Health Nurs. 1996;13(3):167–77.

    Article  CAS  Google Scholar 

  4. Asgary R, Sckell B, Alcabes A, Naderi R, Schoenthaler A, Ogedegbe G. Rates and predictors of uncontrolled hypertension among hypertensive homeless adults using New York city shelter-based clinics. Ann Fam Med. 2016;14(1):41–6.

    Article  Google Scholar 

  5. Bernstein RS, Meurer LN, Plumb EJ, Jackson JL. Diabetes and hypertension prevalence in homeless adults in the United States: a systematic review and meta-analysis. Am J Public Health. 2015;105(2):e46–60.

    Article  Google Scholar 

  6. Breland JY, Chee CP, Zulman DM. Racial differences in chronic conditions and sociodemographic characteristics among high-utilizing veterans. J Racial Ethn Health Disparities. 2015;2(2):167–75.

    Article  Google Scholar 

  7. Pribish A, Khalil N, Mhaskar R, Woodard L, Mirza AS. Chronic disease burden of the homeless: a descriptive study of student-run free clinics in Tampa, Florida. J Community Health. 2019;44(2):249–55.

    Article  Google Scholar 

  8. Zhang M, Garcia A, Bretones G. Demographics and clinical profiles of patients visiting a free clinic in Miami, Florida. Front Public Health. 2019;7:212.

    Article  Google Scholar 

  9. Axon RN, Gebregziabher M, Dismuke CE, Hunt KJ, Yeager D, Ana EJS, et al. Differential impact of homelessness on glycemic control in veterans with type 2 diabetes mellitus. J Gen Intern Med. 2016;31(11):1331–7.

    Article  Google Scholar 

  10. Centers for Disease Control and Prevention (CDC). Hypertension cascade: hypertension prevalence, treatment and control estimates among US adults aged 18 years and older applying the criteria from the American College of Cardiology and American Heart Association’s 2017 Hypertension Guideline—NHANES 2013–2016external icon. Atlanta, GA: US Department of Health and Human Services; 2019.

  11. Statistics About Diabetes https://www.diabetes.org/resources/statistics/statistics-about-diabetes: American Diabetes Association; [accessed on 2020 8-12].

  12. Karr S. Epidemiology and management of hyperlipidemia. Am J Manag Care. 2017;23(9 Suppl):S139–S48.

    PubMed  Google Scholar 

  13. Kim DH, Daskalakis C, Plumb JD, Adams S, Brawer R, Orr N, et al. Modifiable cardiovascular risk factors among individuals in low socioeconomic communities and homeless shelters. Fam Community Health. 2008;31(4):269–80.

    Article  Google Scholar 

  14. Yamane DP, Oeser SG, Omori J. Health disparities in the Native Hawaiian homeless. Hawaii Med J. 2010;69(6 Suppl 3):35–41.

    PubMed  PubMed Central  Google Scholar 

  15. Padgett D, Struening EL, Andrews H. Factors affecting the use of medical, mental health, alcohol, and drug treatment services by homeless adults. Med Care. 1990;28(9):805–21.

    Article  CAS  Google Scholar 

  16. Brown MA, Gellatley W, Hoffman A, Dowdell L, Camac A, Francois R, et al. Medical complications of homelessness: a neglected side of men's health. Intern Med J. 2019;49(4):455–60.

    Article  Google Scholar 

  17. Nielssen O, Chudleigh A, Chen M, Large M, Markovic T, Cooper L. Results of a metabolic health clinic at a hostel for homeless men. Australas Psychiatry. 2017;25(3):270–3.

    Article  Google Scholar 

  18. Whelton PK, Carey RM, Aronow WS, Casey DE Jr, Collins KJ, Himmelfarb CD, et al. ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: executive summary: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines. Hypertension. 2018;71(6):1269–324.

    Article  CAS  Google Scholar 

  19. Juster RP, Russell JJ, Almeida D, Picard M. Allostatic load and comorbidities: a mitochondrial, epigenetic, and evolutionary perspective. Dev Psychopathol. 2016;28(4pt1):1117–46.

    Article  Google Scholar 

  20. Gupta R, Sharma M, Goyal NK, Bansal P, Lodha S, Sharma KK. Gender differences in 7 years trends in cholesterol lipoproteins and lipids in India: insights from a hospital database. Indian J Endocrinol Metab. 2016;20(2):211–8.

    Article  CAS  Google Scholar 

  21. Tharu BP, Tsokos CP. A statistical study of serum cholesterol level by gender and race. J Res Health Sci. 2017;17(3):e00386.

    PubMed  Google Scholar 

  22. Silliman K, Yamanoha MM, Morrissey AE. Evidence of nutritional risk in a population of homeless adults in rural northern California. J Am Diet Assoc. 1998;98(8):908–10.

    Article  CAS  Google Scholar 

  23. Wiecha JL, Dwyer JT, Dunn-Strohecker M. Nutrition and health services needs among the homeless. Public Health Rep. 1991;106(4):364–74.

    CAS  PubMed  PubMed Central  Google Scholar 

  24. Behavioral health services for people who are homeless. SAMHSA/CSAT Treatment Improvement Protocols. Rockville (MD)2013.

  25. Gross GA. Drug and alcohol abuse and cholesterol levels. J Am Osteopath Assoc. 1994;94(1):55–6 61-2.

    CAS  PubMed  Google Scholar 

  26. Santolaria F, Perez-Manzano JL, Milena A, Gonzalez-Reimers E, Gomez-Rodriguez MA, Martinez-Riera A, et al. Nutritional assessment in alcoholic patients. Its relationship with alcoholic intake, feeding habits, organic complications and social problems. Drug Alcohol Depend. 2000;59(3):295–304.

    Article  CAS  Google Scholar 

  27. Morris AF, K. Hyperlipidemia in racial/ethnic minorities: differences in lipid profiles and the impact of statin therapy. Clinical Lipidology. 2009;4(6):14.

    Article  Google Scholar 

  28. Frank AT, Zhao B, Jose PO, Azar KM, Fortmann SP, Palaniappan LP. Racial/ethnic differences in dyslipidemia patterns. Circulation. 2014;129(5):570–9.

    Article  CAS  Google Scholar 

  29. Selvin E. Are there clinical implications of racial differences in HbA1c? A difference, to be a difference, must make a difference. Diabetes Care. 2016;39(8):1462–7.

    Article  CAS  Google Scholar 

  30. Freedman DS, Strogatz DS, Eaker E, Joesoef MR, DeStefano F. Differences between black and white men in correlates of high density lipoprotein cholesterol. Am J Epidemiol. 1990;132(4):656–69.

    Article  CAS  Google Scholar 

  31. Centers for Disease C, Prevention. Disparities in screening for and awareness of high blood cholesterol--United States, 1999-2002. MMWR Morb Mortal Wkly Rep. 2005;54(5):117–9.

    Google Scholar 

  32. Lackland DT. Racial differences in hypertension: implications for high blood pressure management. Am J Med Sci. 2014;348(2):135–8.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Clinical Laboratory Sciences, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA

    Jie Gao

  2. Physician Assistant Studies, School of Health Professions, University of Alabama at Birmingham, 1720 2nd AVE S, Birmingham, AL, 35294, USA

    Tosi Monifa Gilford & Wei Li

  3. Occupational Therapy, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA

    Hon K Yuen

  4. Biomedical Sciences, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA

    Myung Hwan Jeon, Courtney Carraway, Gyusik Park, Stephanie Diel & Alex Patel

  5. Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China

    Ge Wang

  6. Nutrition Sciences, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA

    Brianna Miller

Authors
  1. Jie Gao
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tosi Monifa Gilford
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hon K Yuen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Myung Hwan Jeon
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Courtney Carraway
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Gyusik Park
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Stephanie Diel
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Alex Patel
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Ge Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Brianna Miller
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Wei Li
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Jie Gao, Hon K Yuen, and Wei Li contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Jie Gao, Tosi Monifa Gilford, Hon K Yuen, Myung Hwan Jeon, Courtney Carraway, Gyusik Park, Stephanie Diel, Alex Patel, Ge Wang, Brianna Miller, and Wei Li. The first draft of the manuscript was written by Jie Gao, Hon K Yuen, and Wei Li. All the authors commented on the previous version of the manuscript. All the authors read and approved the final version of the manuscript.

Corresponding author

Correspondence to Wei Li.

Ethics declarations

Ethics Approval and Consent to Participate

Ethics approval was received. Consent to participate is not applicable.

Consent for Publication

Yes

Conflict of Interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gao, J., Gilford, T.M., Yuen, H.K. et al. Racial Differences in Prevalence of Cardiometabolic Morbidities Among Homeless Men. J. Racial and Ethnic Health Disparities 9, 456–461 (2022). https://doi.org/10.1007/s40615-021-00976-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40615-021-00976-y

Keywords

Search

Navigation