Characteristics of homeless persons hospitalized in health care facilities in the Czech Republic in 2006–2015
Authors:
M. Malý 1
; H. Orlíková 2
; J. Kynčl 2,3
; B. Kříž 2,3*
Authors place of work:
Oddělení biostatistiky, Státní zdravotní ústav, Praha
1; Oddělení epidemiologie infekčních nemocí, Centrum epidemiologie a mikrobiologie, Státní zdravotní ústav, Praha
2; Ústav epidemiologie a biostatistiky, 3. lékařská fakulta Univerzity Karlovy, Praha
3
Published in the journal:
Epidemiol. Mikrobiol. Imunol. 71, 2022, č. 1, s. 21-31
Category:
Original Papers
Summary
Aim: Homelessness is a social, societal, economic, and health problem. The aim of the study was to describe the characteristics of hospitalized homeless persons in the Czech Republic in relation to their health status and to propose targeted measures for improvement.
Material and methods: The study used anonymous data from the National Registry of Hospitalized Patients from 2006–2015, including the primary diagnosis at hospital admission and up to five additional diagnoses according to the 10th revision of the International Classification of Diseases (ICD-10). The basic statistical unit is the completed case of hospitalization of a homeless person in an inpatient health care facility such as hospital or nursing home.
Results: Over the 10-year study period (2006-2015), 3387 homeless persons, 77.5% of them male, were admitted to inpatient health care facilities in the Czech Republic. The length of hospital stay tended to decrease over the years, with a median of six days. The majority of hospitalized homeless persons were aged between 40 and 69 years. Their distribution by type of health care facility: 2,710 (80.0%) were admitted to hospitals, 468 (13.8%) to psychiatric hospitals, 180 (5.3%) to long-term care facilities, and 29 (0.9%) to tuberculosis and respiratory disease hospitals. According to the mode of termination of hospitalization, 2189 (64.6%) homeless persons were discharged to their original environment, 280 (8.3%) were transferred to an after-care facility, 277 (8.2%) were transferred to an acute care facility, 222 (6.6%) left against medical advice, 180 (5.3%) were transferred to another ward, and 80 (2.4%) were transferred to a social care facility. A total of 159 (4.7%) in-hospital deaths occurred. The underlying causes of hospitalization according to ICD-10 were mostly those under Chapter V - Mental and behavioural disorders (19.9%) and Chapter XIX - Injury, poisoning and certain other consequences of external causes (18.1%). Among the 175 cases with a primary diagnosis from Chapter I - Certain infectious and parasitic diseases, the most common conditions were scabies, pediculosis, mycosis, bacterial infections, and tuberculosis.
Conclusion: Data on hospital admissions is one of the important tools for monitoring the health of homeless people. They illustrate the seriousness of the situation of homeless people and point to the need to obtain more information on this issue in order to improve the availability of specific health care and social care for sick homeless people. Prevention programs, residential services, and specific outreach health and social activities can contribute to reducing the negative impacts.
Keywords:
hospitalization – the homeless – health care and social care services
Zdroje
1. Koncepce prevence a řešení problematiky bezdomovectví v České republice do roku 2020. Praha: Ministerstvo práce a sociálních věcí České republiky [online] 2013. ISBN 978-80-7421- 072-3. [cit. 2021-01-16]. Dostupné na www: https://www.mpsv. cz/koncepce-prevence-a-reseni-problematiky-bezdomovectvi-vcr- do-roku-2020.
2. EU homelessness strategy. Declaration of the European Parliament of 16 December 2010 on an EU homelessness strategy [online] 2010. [cit. 2021-01-16]. Dostupné na www: https:// www.europarl.europa.eu/doceo/document/TA-7-2010-0499_ EN.html.
3. ETHOS – European Typology of Homelessness and housing exclusion, FEANTSA [online]. [cit. 2021-01-16]. Dostupné na www: https://www.feantsa.org/download/en- 16822651433655843804.pdf ; ETHOS – Evropská typologie bezdomovství a vyloučení z bydlení v prostředí ČR, FEANTSA [online]. [cit. 2021-01-16]. Dostupné na www: https://www. feantsa.org/download/cz___8621229557703714801.pdf.
4. FEANTSA – European Federation of National Organisations Working with the Homeless. What is FEANTSA [online]. [cit. 2021-10-20]. Dostupné na www: https://www.feantsa.org/en/ about-us/what-is-feantsa.
5. Edgar B. European review of statistics on homelessness, Sixth review [online]. Brussels: European Federation of National Organisations Working with the Homeless, FEANTSA, 2009 [cit. 2021-01-16]. Dostupné na www: https://www.feantsaresearch. org/download/6-20098376003316223505933.pdf.
6. Hradecký I, Barták M, Cveček D, et al. Definice a typologie bezdomovství [online]. Praha: Naděje, 2007 [cit. 2021-01-16]. Dostupné na www: https://www.nadeje.cz/img-content/files/ docs/odborne/2007dtbezdm.pdf.
7. Hradecký I. Národní zpráva o bezdomovectví v České republice 2005 (The National Report on Homelessness 2005 prepared for European Observatory on Homelessness) [online]. 2005 [cit. 2021-01-16]. Dostupné na www: https://www.nadeje.cz/ img-content/files/docs/odborne/2005nzob_en.pdf.
8. Zpráva o plnění Koncepce prevence a řešení problematiky bezdomovectví v České republice do roku 2020 za rok 2020 [online]. Praha: Ministerstvo práce a sociálních věcí; 2021 [cit. 2021-11-02]. Dostupné na www: https://www.mpsv.cz/documents/ 20142/225517/Zpráva+o+plnění+Koncepce+prevence+ a+řešení+problematiky+bezdomovectví+v+ČR+do+ro ku+2020+za+rok+2020.pdf.
9. Better data and policies to fight homelessness in the OECD. Policy brief on affordable housing [online]. Paris: OECD; 2020 [cit. 2021-10-29]. Dostupné na www: http://oe.cd/homelessness- 2020.
10. Dvořáčková D, Belešová R, Kajanová A, Bergougui B. Health and social aspects of homelessness. Kontakt, 2016;18(3):e179– e183; Dostupné na www: http://dx.doi.org/10.1016/j.kontakt. 2016.08.004.
11. Marek J, Strnad A, Hotovcová L. Bezdomovectví v kontextu ambulantních sociálních služeb. Praha: Portál; 2012.
12. Hradecký I. Profily bezdomovství v České republice. Proč spí lidé venku a kdo jsou ti lidé. Tematická zpráva 2005 zpracovaná pro Evropskou observatoř bezdomovství [online]. 2005 [cit. 2021- 01-16]. Dostupné na www: https://www.nadeje.cz/img-content/ files/docs/odborne/pslvakj05cz.pdf.
13. Baptista I, Marlier E. Fighting homelessness and housing exclusion in Europe: A study of national policies [online]. European Social Policy Network (ESPN), Brussels: European Commission; 2019 [cit. 2021-10-29]. Dostupné na www: https://ec.europa. eu/social/main.jsp?catId=738&langId=en&pubId=8243&furtherPubs= yes.
14. Wickham S. Effective interventions for homeless populations: the evidence remains unclear. Lancet Public Health, 2020;5(6):e304–e305.
15. Obyvatelstvo podle způsobu bydlení. Sčítání lidu, domů a bytů, 2011 [online]. Praha: Český statistický úřad; 2014 [cit. 2021-01- 16]. Dostupné na www: https://www.czso.cz/csu/czso/obyvatelstvo- podle-zpusobu-bydleni-2011-x4dkqoclsq.
16. Kuchařová V, Janurová K. Velikost a struktura skupin osob bez domova a osob vyloučených z bydlení [online]. Praha: VÚPSV, v. v. i.; 2016 [cit. 2021-01-16]. Dostupné na www: https://sad-cr.cz/ velikost-a-struktura-skupin-osob-bez-domova-a-osob-vyloucenych- z-bydleni/.
17. Nešporová O, Holpuch P, Janurová K, Kuchařová V. Sčítání osob bez domova v České republice 2019. Kategorie bez střechy a vybrané kategorie bez bytu podle typologie ETHOS [online]. Praha: Výzkumný ústav práce a sociálních věcí, v. v. i.; 2019 [cit. 2021-01-16].
18. Fazel S, Geddes JR, Kushel M. The health of homeless people in high-income countries: descriptive epidemiology, health consequences, and clinical and policy recommendations. Lancet, 2014;384(9953):1529–1540.
19. Odehnalová A. Úvod do psychopatologie a sociální patologie. In: Janoušková K, Nedělníková D, Eds. Profesní dovednosti terénních pracovníků [online]. Ostrava: Ostravská univerzita; 2008. s. 270–297 [cit. 2021-01-16]. Dostupné na www: https:// projekty.osu.cz/tsp/dokumenty/sbornik_tp.pdf. ISBN 978-80- 7368-503-4.
20. Dutka J, Glumbíková K, Čada K. Zdraví obyvatel postrádajících standardní bydlení [online]. Praha: MPSV; 2018 [cit. 2021-01-16]. Dostupné na www: http://www.socialnibydleni.mpsv.cz/images/ soubory/Ostatni/Zdraví_obyvatel_postrádajících_standardní_ bydlení.pdf.
21. Medcalf P, Russell GK. Homeless healthcare: raising the standards. Clin Med (Lond), 2014;14(4):349–353.
22. Šupková D, Pešek J, Trnka L, Vidovičová H, Volná J. Zdravotní péče o bezdomovce v ČR [online]. Praha: Grada Publishing; 2007 [cit. 2021-01-16]. Dostupné na www: https://nadeje.cz/ img-content/files/docs/odborne/2007zpb.pdf. ISBN 978-80- 247-2245-0.
23. Dragomirecká E, Kubisová D, Anděl M. Duševní zdraví pražských bezdomovců. Psychiatrie, 2004;8(4):274–279.
24. Zdraví 2030 – Strategický rámec rozvoje péče o zdraví v České republice do roku 2030 [online]. Praha: Ministerstvo zdravotnictví České republiky; 2020 [cit. 2021-10-20]. Dostupné na www: https://www.mzcr.cz/vlada-schvalila-strategicky-ramec-zdravi- 2030-2/.
25. Strategie sociálního začleňování 2021–2030 [online]. Praha: Ministerstvo práce a sociálních věcí; 2020 [cit. 2021-10-20]. Dostupné na www: https://www.mpsv.cz/strategie-socialniho- zaclenovani-2021-2030.
26. Ni Cheallaigh C, Cullivan S, Sears J, et al. Usage of unscheduled hospital care by homeless individuals in Dublin, Ireland: a cross-sectional study. BMJ Open, 2017;7(11): e016420.
27. National strategies for combating homelessness [online]. Paris: OECD; 2021 [cit. 2021-11-12]. Dostupné na www: https://www. oecd.org/els/family/HC3-2-Homeless-strategies.pdf.
28. Zólyomi E, Fuchs M, Simmons C, Geyer L, Sandu V, Rodrigues R, Birtha M. Mapping trends and policies to tackle homelessness in Europe [online]. Vienna: European Centre for Social Welfare Policy and Research; 2021 [cit. 2021-11-15]. Dostupné na www: https://www.euro.centre.org/publications/detail/4012.
29. Hospitalizovaní v nemocnicích ČR [online]. Praha: Ústav zdravotnických informací a statistiky ČR; 2021 [cit. 2021-12-10]. Dostupné na www: https://www.uzis.cz/index.php?pg=vystupy-- tematicke-rady&id=738.
30. Sixth overview of housing exclusion in Europe 2021 [online]. Foundation Abbe Pierre and FEANTSA; 2021 [cit. 2021-11-03]. Dostupné na www: https://www.fondation-abbe-pierre.fr/documents/ pdf/rapport_europe_2021_gb.pdf.
31. Harmonisation of definitions of homelessness for UK Official Statistics: A feasibility report [online]. Government Statistical Service; 2019 [cit. 2021-11-03]. Dostupné na www: https://gss. civilservice.gov.uk/wp-content/uploads/2019/02/GSS-homelessness- report-1.pdf.
32. Pekárková A. Pouliční medicína. Vita Nostra Revue, 2016;26(3):48– 51.
33. Rae BE, Rees S. The perceptions of homeless people regarding their healthcare needs and experiences of receiving health care. J Adv Nurs, 2015;71(9):2096–2107.
34. Grech E, Raeburn T. Experiences of hospitalised homeless adults and their health care providers in OECD nations: A literature review. Collegian, 2019;26(1):204–211.
35. Romero-Ortuno R, O’Riordan D, Silke B. Profiling the medical admissions of the homeless. Acute Medicine, 2012;11(4):197–204.
36. Kubisová D, Dlouhý P, Rambousková J, Anděl M. Absence of protein- energy malnutrition in Prague homeless. Int J Public Health, 2008;53(1):57–63.
37. Wadhera RK, Choi E, Shen C, Yeh RW. Joynt Maddox KE. Trends, causes, and outcomes of hospitalizations for homeless individuals. A retrospective cohort study. Med Care, 2019;57(1):21–27.
38. Beijer U, Wolf A, Fazel S. Prevalence of tuberculosis, hepatitis C virus, and HIV in homeless people: a systematic review and meta- analysis. Lancet Infect Dis, 2012;12(11):859–870.
39. Kubín M, Malý M, Jágrová Z. Podíl bezdomovců na incidenci tuberkulózy v Praze. Studia pneumologica et phthiseologica, 2016;76(2):67–72.
40. Goetsch U, Bellinger OK, Buettel KL, Gottschalk R. Tuberculosis among drug users and homeless persons: impact of voluntary X-ray investigation on active case finding. Infection, 2012;40(4):389–395.
41. Second overview of housing exclusion in Europe 2017 [online]. Brussels: The Foundation Abbé Pierre – FEANTSA; 2017 [cit. 2021-01-16]. Dostupné z www: https://www. feantsa.org/download/gb_housing-exclusion-report_complete_ 20178613899107250251219.pdf.
42. Aldridge RW, Menezes D, Lewer D, et al. Causes of death among homeless people: a population-based cross-sectional study of linked hospitalisation and mortality data in England. Wellcome Open Res, 2019;4:49.
43. Balla S, Alqahtani, F, Alhajji M, Alkhouli, M. Cardiovascular outcomes and rehospitalization rates in homeless patients admitted with acute myocardial infarction. Mayo Clin Proc, 2020;95(4):660–668.
44. Davídkovová H, Plavcová E, Kynčl J, Kyselý J. Impacts of hot and cold spells differ for acute and chronic ischaemic heart diseases. BMC Public Health, 2014;14:480.
45. O’Flaherty, B. Homelessness research: A guide for economists (and friends). Journal of Housing Economics, 2019;44:1–25.
46. Pleace N, Baptista I, Knutagård M. Housing first in Europe: An overview of implementation, strategy and fidelity [online]. Brussels: Housing First Europe Hub, 2019 [cit. 2021-11-03]. Dostupné na www: https://housingfirsteurope.eu/assets/ files/2019/10/2019-10-10-HFinEurope_Full-Report2019_final. pdf.
Štítky
Hygiene and epidemiology Medical virology Clinical microbiologyČlánok vyšiel v časopise
Epidemiology, Microbiology, Immunology
2022 Číslo 1
Najčítanejšie v tomto čísle
- Next generation probiotics: an overview of the most promising candidates
- Overview of basic epidemiological characteristics and descriptive analysis of the incidence of human yersiniosis in the Czech Republic in 2018–2020
- Decreasing neutralization antibody levels following vaccination against SARS-CoV-2 in the elderly: an observational study in Southern Moravia, Czech Republic
- Prevalence of SARS-COV-2 antibodies in the Thomayer University Hospital staff after the first wave of COVID-19