Aging homeless population: filling the gaps. Age of onset of chronic diseases depending on drug use

Abstract

Background. Homelessness is a serious public health problem that affects more than 31.000 people in Spain. It is a population that is aging, with important consequences for their health, causing among other things a greater prevalence of chronic diseases. Also, within this aging homeless population, there is a high proportion of people who use drugs, they are called "aging drug users". This consumption adds a risk to an already vulnerable population.

Aim. Describe the population of aging problematic drug users regarding the age of onset of the first chronic diseases and compare it with the rest of the homeless population depending on drug use, both those who have a non-problematic consumption and those who do not use drugs.

Methods. A retrospective cohort study was conducted in the homeless population served in the city of Girona from 2006 to 2016.The information includes clinical data from January 1, 2000 to December 31, 2016, collected thanks to electronic records of primary care and the mental health centre of Girona. Data included sociodemographic, chronic and infectious diseases, substance misuse disorder. The average healthy months and years the person passes until the onset of the

first chronic diseases is compared in the 3 different groups of consumption using the Kruskal- Walls test. The Kaplan-Meier test was used to determine the probability of being healthy over

time in the 3 consumption groups.

Results. The sample consisted of 492 participants. Homeless men were accounted for 84.5% of the sample. The mean age of the cohort was 49.7 years (SD 11,09) for men and 49.29 years (SD 13,6) for women. In relation to drug use, 59.1% of the sample has no substance misuse problem, 31,9% had a non-problematic drug use, and 18,1% of the total were problem drug users. About chronic diseases that were recorded in the electronic registry of the PCC, 152 people had al least one. We focus now only on those people over 40, who represent 80% of the sample. Within this older group, non-consumers still are the larger group, representing 44.9% of the people over 40. Aging problematic drug users represent 14% of the sample and those people over 40 who use other drugs represent 21,1% of the sample. Within this aging group, we have the date of diagnosis of the different chronic diseases registered of 115 people. The age of onset of the first chronic disease for each group is; 42,2 years for aging problematic drug users, 52,25 years for other drug use group and 51,25 years for no substance misuse group.

Conclusions. We can conclude that there are differences in the time of appearance of chronic diseases in individuals experiencing homelessness classified depending on their drug consumption, being the "aging problematic drug users" those exposed to an earlier onset of them. However, we cannot assure the association between consumption and the age of appearance