Diabetes care and its predictors among persons experiencing homelessness compared with domiciled adults with diabetes in New York City; An observational study

Ramin Asgary; Elena Beideck; Rosanna Naderi

doi:10.1016/j.eclinm.2022.101418

Diabetes care and its predictors among persons experiencing homelessness compared with domiciled adults with diabetes in New York City; An observational study

EClinicalMedicine. 2022 Apr 28:48:101418. doi: 10.1016/j.eclinm.2022.101418. eCollection 2022 Jun.

Authors

Ramin Asgary^{1

2}, Elena Beideck², Rosanna Naderi¹

Affiliations

¹ Milken Institute School of Public Health, George Washington University, 950 New Hampshire Ave NW, Washington, D.C. 20052, USA.
² Weill Cornell Medical College of Cornell University, 525 East 68th Street, New York, NY 10065, USA.

Abstract

Background: There is a dearth of data regarding diabetes control among patients experiencing homelessness.

Methods: We retrospectively collected type 2 diabetes-related measurements, sociodemographic, and clinical indicators from medical records of all incoming adults with diabetes (n = 418; homeless: 356 and domiciled: 58) seen in shelter-clinics in New York City in 2019. The outcomes were the rates of inadequately managed diabetes and associated factors.

Findings: Bivariate analysis showed that patients experiencing homelessness (63% Black; 32% Hispanic) 134/304 (43⋅9%) were more likely than domiciled patients 13/57 (22·8%) to have inadequately managed diabetes (OR 2⋅67, CI 1·38-5·16, p = 0⋅003). The average HbA1c among homeless (8·4%, SD± 2·6) was higher than that of domiciled persons (7·3%, SD± 1·8, p = 0·002). In logistic regression, domiciled status (OR 0⋅ 42, CI 0·21 - 0·84, p = 0·013), older age (OR 0·97, CI 0·95 - 0·99, p = 0·004), and non-Hispanic/Latino ethnicity were associated with well-managed diabetes. Among persons experiencing homelessness, non-Hispanic/Latino (OR 0·61, CI 0·37-0·99, p = 0·047) and older age (0·96, CI 0·94-0·99, p = 0·003) were associated with well-managed diabetes. In linear regression, mental illness (-0·11, p = 0·048) and older age (-0·15, p = 0·010) were associated with lower HbA1c, suggesting better support in respective shelters. There was no statistically significant association between inadequately managed diabetes with several traditional risk factors including substance or alcohol use disorder, health insurance, or other chronic diseases.

Interpretation: Interventions at shelters or shelter-clinics should target subgroups in addition to addressing traditional risk factors to improve diabetes control. mHealth strategies could be considered to improve engagement, care delivery, and medication taking. Ultimately, homelessness itself needs to be addressed.

Funding: There are no funding sources to declare.

Keywords: BMI, body mass index; BP, blood pressure; CAD, coronary artery disease; CKD, chronic kidney disease; DM, diabetes mellitus; Diabetes mellitus; GFR, glomerular filtration rate; HTN, hypertension; HbA1c, hemoglobin A1c; Health disparities; Homeless; LDL, low density lipoprotein; PCP, primary care physician; Primary care; Quality care.