Objectives: To identify: (i) risk of cardiovascular disease
(CVD) in homeless versus housed individuals and (ii)
interventions for CVD in homeless populations.
Methods: We conducted a systematic literature
review in EMBASE until December 2018 using a search
strategy for observational and interventional studies
without restriction regarding languages or countries.
Meta-analyses were conducted, where appropriate and
possible. Outcome measures were all-cause and CVD
mortality, and morbidity.
Results: Our search identified 17 articles (6 case-control,
11 cohort) concerning risk of CVD and none regarding
specific interventions. Nine were included to perform a
meta-analysis. The majority (13/17, 76.4%) were high
quality and all were based in Europe or North America,
including 765 459 individuals, of whom 32 721 were
homeless. 12/17 studies were pre-2011. Homeless
individuals were more likely to have CVD than nonhomeless individuals (pooled OR 2.96; 95% CI 2.80 to
3.13; p<0.0001; heterogeneity p<0.0001; I
2
=99.1%)
and had increased CVD mortality (age-standardised
mortality ratio range: 2.6–6.4). Compared with nonhomeless individuals, hypertension was more likely in
homeless people (pooled OR 1.38–1.75, p=0.0070;
heterogeneity p=0.935; I
2
=0.0%).
Conclusions: Homeless people have an approximately
three times greater risk of CVD and an increased CVD
mortality. However, there are no studies of specific
pathways/interventions for CVD in this population. Future
research should consider design and evaluation of tailored
interventions or integrating CVD into existing intervention
