Homelessness associated with increased rates of skin conditions

Those experiencing homelessness had higher rates of developing skin conditions compared with the general population, and this risk increased after contact with a homeless shelter, according to a study.

“The prevalence of skin conditions is estimated to range between 17% to 54% in adults experiencing homelessness in high-income countries, but few studies compare rates with those of the general population,” Sandra F. Nilsson, PhD, of the Copenhagen Research Center for Mental Health at Copenhagen University Hospital and the department of clinical medicine at University of Copenhagen in Denmark, and colleagues wrote.

In this cohort study, researchers examined the association between homelessness and diagnosed skin conditions, prescribed medication and type of consultation.

Records from a total of 5,054,238 individuals (50.6% female; mean age at start, 39.4 years; standard deviation, 21.1 years) totaling 73,477,258 person-years at risk were compiled and analyzed from the Danish nationwide health, social and administrative registers from Jan. 1, 1999, to Dec. 31, 2018.

Results showed that 15% of the cohort received a skin diagnosis and 0.7% experienced at least one episode of homelessness. Those who experienced homelessness exhibited a 2.31-times (95% CI, 2.25-2.36) higher incidence rate ratio (IRR) for any diagnosed skin condition.

Of the diagnoses most probable among those experiencing homelessness, infections of the skin and sub-cutaneous tissue were the highest at 14% followed by erysipelas (7.6%) and ulcers (4.3%), whereas the probability was low for impetigo (0.4%) and scabies (0.2%).

Additionally, those experiencing homelessness had lower rates of skin cancer, with 2.8% (95% CI, 2.5%-3%) receiving a neoplasm diagnosis compared with 5.1% (95% CI, 4.9%-5.3%) of their counterparts.

Patients experiencing vs. not experiencing homelessness had a higher adjusted incidence rate ratio of any dermatological treatment (aIRR = 1.16; 95% CI, 1.13-1.19) as well.

Those who experienced homelessness had a 2.54-fold (95% CI, 2.48-2.61) higher rate of non-dermatological consultations resulting in a diagnosed skin condition compared with those who did not experience homelessness. Additionally, homelessness was also associated with a 3.04-fold (95% CI, 2.9-3.17) higher rate of receiving any skin diagnosis in an emergency room consultation.

Those with homeless shelter contact experienced a 2.9% (95% CI, 2.7%-3.1%) increased rate of skin condition diagnoses compared with individuals without homeless shelter contact (0.8%; 95% CI, 0.8%-0.9%). Further, compared with those with no homeless shelter contacts, those who had at least five homeless shelter contacts within a year of a first contact had an adjusted incidence rate ratio of 7.33 (95% CI, 5.57-9.65) for a diagnosed skin condition. As a result, the authors emphasized that the time following the first contact with a homeless shelter is the most important window of opportunity for treatment.

“Preventing homelessness and helping people into housing remain the major issues to address with likely beneficial effects on skin problems,” Nilsson and colleagues wrote.