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Study: 30-year CVD risk high in homeless adults with mental illness
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Homeless adults with mental illness, particularly men and those with substance dependence, have an elevated 30-year risk for coronary death, MI and stroke, according to a new report.
Researchers analyzed 352 homeless adults with mental illness in Toronto who were participating in the At Home/Chez Soi Project. They calculated 30-year risk for CVD, including coronary death, MI and stroke, and examined it for association with need for mental health services, diagnosis of psychotic disorder, sex, ethnicity, access to a family physician and substance dependence.
The 30-year risk for CVD was 24.5%. According to the researchers, this risk is more than double the reference normal of 10.1%. The reference normal is an age- and sex-adjusted idealized risk factor profile: no smoking, no diabetes, normal BP and normal BMI.
In addition, 30-year CVD risk was greater among men (unadjusted OR = 3.99; 95% CI, 2.47-6.56; adjusted OR = 4.71; 95% CI, 2.76-8.05) and those diagnosed with substance dependence at baseline (unadjusted OR = 1.94; 95% CI, 1.23-3.06; adjusted OR = 1.78; 95% CI, 1.05-3). In an unadjusted model, nonwhite race/ethnicity was associated with lower 30-year CVD risk (OR = 0.62; 95% CI, 0.39-0.97), but this was attenuated after adjustment (OR = 0.76; 95% CI, 0.45-1.3).
The researchers found no differences in 30-year CVD risk based on need for mental health services, diagnosis of psychotic disorder or access to family physician.
“Many of the factors that we thought would be associated with the 30-year [CV] risk among homeless adults were actually not significant,” Agnes Gozdzik, PhD, research associate in the Center for Research in Inner City Health of St. Michael’s Hospital, Toronto, said in a press release. “However, if you are homeless and having a mental illness and are a male or have a substance abuse disorder, your risk of 30-year [CVD] appears to be much higher even if you do not show the typical predictors such as high BMI or hypertension, etc. This is something that clinicians who work with this population should be aware of.” – by Erik Swain
Disclosure: Gozdzik reports no relevant financial disclosures.
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