Dermatological diagnoses among people experiencing homelessness in the USA

The experience of homelessness is a growing problem in the USA. Environmental exposures, chronic medical conditions and barriers to personal hygiene could increase risk of dermatological disease.

To evaluate the association of homelessness with receiving a dermatological diagnosis and to compare dermatological diagnoses between unhoused and housed individuals.

We conducted a cross-sectional study of the 'All of Us' database, a national dataset from the USA with detailed participant-reported housing information. We constructed logistic regression models with dermatological diagnosis as binary outcome, housing status as binary exposure, and age, gender, race and ethnicity, geographical region, educational attainment, serious mental illness, alcohol-use disorder, and cocaine, opioid or stimulant drug use as confounders.

Among 257 701 participants, people experiencing homelessness had lower odds of being diagnosed with any dermatological disease [adjusted odds ratio (aOR) 0.68, 95% confidence interval (CI) 0.63-0.72; P < 0.001]. Of participants with at least one dermatological diagnosis, people experiencing homelessness had greater odds of being diagnosed with bacterial skin infections (aOR 2.20, 95% CI 1.5-2.50; P < 0.001) and ectoparasitic disease (aOR 3.12, 95% CI 2.30-4.17; P < 0.001) but lower odds of all other diseases.

Our results underscore the need to improve access to care and water, sanitation and hygiene services for people experiencing homelessness to reduce risk of bacterial skin infection and ectoparasitic infestations.