Stroke Care and Outcomes Among Patients Experiencing Homelessness: A Systematic Review and Meta-Analysis

Area of Science:

• Neurology
• Public Health
• Health Services Research

Background:

• Homelessness is linked to increased stroke risk due to uncontrolled vascular factors and limited healthcare access.
• The impact of homelessness on acute stroke care and patient outcomes is not well understood.

Purpose of the Study:

• To systematically review and meta-analyze existing evidence on acute stroke care for patients experiencing homelessness (PEH).
• To compare outcomes between PEH and housed patients regarding mortality, diagnostics, therapeutics, and discharge.

Main Methods:

• A comprehensive search of multiple databases (PubMed, EMBASE, etc.) was conducted from 2000-2024.
• Included were observational studies of adult stroke patients with documented homelessness; excluded were animal/pediatric studies.
• Meta-analysis pooled relative risk for outcomes like mortality, IVT use, and discharge destination.

Main Results:

• Seven studies involving over 620,000 PEH and 3 million housed patients were analyzed.
• No significant difference in in-hospital mortality was found between PEH and housed patients.
• PEH were less likely to receive intravenous thrombolysis (IVT) and more likely to be discharged to self-care or against medical advice.

Conclusions:

• Patients experiencing homelessness with stroke face disparities, receiving less IVT and post-stroke support.
• Further research is crucial to understand long-term outcomes and reduce care gaps for PEH with stroke.