Health-related quality of life and prevalence of six chronic diseases in homeless and housed people: A cross-sectional study in London and Birmingham, England

Dan Lewer*, Robert W. Aldridge, Dee Menezes, Clare Sawyer, Paola Zaninotto, Martin Dedicoat, Imtiaz Ahmed, Serena Luchenski, Andrew Hayward, Alistair Story

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

26 Citations (Scopus)


Objectives To compare health-related quality of life and prevalence of chronic diseases in housed and homeless populations. Design Cross-sectional survey with an age-matched and sex-matched housed comparison group. Setting Hostels, day centres and soup runs in London and Birmingham, England. Participants Homeless participants were either sleeping rough or living in hostels and had a history of sleeping rough. The comparison group was drawn from the Health Survey for England. The study included 1336 homeless and 13 360 housed participants. Outcome measures Chronic diseases were self-reported asthma, chronic obstructive pulmonary disease (COPD), epilepsy, heart problems, stroke and diabetes. Health-related quality of life was measured using EQ-5D-3L. Results Housed participants in more deprived neighbourhoods were more likely to report disease. Homeless participants were substantially more likely than housed participants in the most deprived quintile to report all diseases except diabetes (which had similar prevalence in homeless participants and the most deprived housed group). For example, the prevalence of chronic obstructive pulmonary disease was 1.1% (95% CI 0.7% to 1.6%) in the least deprived housed quintile; 2.0% (95% CI 1.5% to 2.6%) in the most deprived housed quintile; and 14.0% (95% CI 12.2% to 16.0%) in the homeless group. Social gradients were also seen for problems in each EQ-5D-3L domain in the housed population, but homeless participants had similar likelihood of reporting problems as the most deprived housed group. The exception was problems related to anxiety, which were substantially more common in homeless people than any of the housed groups. Conclusions While differences in health between housed socioeconomic groups can be described as a slope', differences in health between housed and homeless people are better understood as a cliff'.

Original languageEnglish
Article numbere025192
JournalBMJ Open
Issue number4
Publication statusPublished - 1 Apr 2019
Externally publishedYes

Bibliographical note

Funding Information:
Funding DL is funded by an NIHR Doctoral Research Fellowship (DRF-2018-11-ST2-016). RWA is funded by a Wellcome Trust Clinical Research Career Development Fellowship (206602/Z/17/Z). IA is funded by Sandwell Hospital and Public Health England. SL is funded by an NIHR Clinical Doctoral Research Fellowship (ICA-CDRF-2016-02-042).

Publisher Copyright:
© Author(s) (or their employer(s)) 2019. Published by BMJ.


  • epidemiology
  • homelessness
  • inequality
  • public health


Dive into the research topics of 'Health-related quality of life and prevalence of six chronic diseases in homeless and housed people: A cross-sectional study in London and Birmingham, England'. Together they form a unique fingerprint.

Cite this