Association between health status and homeless chronicity among individuals attending community-based organizations in San Juan, Puerto Rico
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Background: Homeless populations have disclosed in many studies their particular needs of health care services, histories of hospitalization, chronic health conditions and mental illnesses. This study assessed the physical and mental health status across residential status of individuals attending community-based organizations (CBOs) in San Juan, Puerto Rico (PR). Methods: We performed a cross-sectional survey of 100 individuals aged 21-82 years enrolled in two CBOs that offer services to homeless in San Juan, PR. Face-to-face interviews collected information on socio-demographics, substance use, and access to medical care. The SF-36 Health Survey version 1.0 was administered to assess health status providing eight norm-based subscales, a Physical Component Summary (PCS) and a Mental Component Summary (MCS). Scores at or below the median were defined as poor physical or mental health status. Multiple logistic regression models were estimated to evaluate the association between health status and homeless chronicity. Models for PCS and MCS were generated separately and adjusted prevalence odds ratios (POR) were calculated. Results: Residential status was distributed as follows: 56.0% on-the-street homeless, 9.0% transitionally-housed and 35.0% housed. Mean PCS and MCS scores were 49.6±11.8 and 42.2±14.4, respectively. MCS unadjusted POR for on-the-street and transitionally homeless individuals were 2.88 (95% CI: 1.22-6.77) compared to housed individuals. PCS unadjusted POR for on-the-street and transitionally homeless individuals were 1.58 (95% CI: 0.56-4.43) compared to housed individuals. After adjusting for polydrug use and CBO as a random intercept, on-the-street and transitionally homeless were 2.57 (95% CI: 1.07-6.17) times more likely to have a poor mental health status than housed individuals. After adjusting for HIV, anxiety disorder and CBO as a random intercept, on-the-street and transitionally homeless were 1.27 (95% CI: 0.52-3.11) times more likely to have a poor physical health status than housed individuals. Conclusions: These findings underscore the need for more aggressive prevention and treatment programs targeting homeless adults in San Juan, PR.