Korean J Med.  2014 May;86(5):585-592.

The Quality of Medical Care Provided to Homeless Diabetes Patients in a General Hospital in Seoul, and the Prevalence of Diabetes Comorbidities

• Beom SH
• Oh MK
• Ahn CW

Abstract

BACKGROUND/AIMS
As an underprivileged population, homeless people have a higher incidence of morbidity and mortality than do non-homeless people. Diabetes mellitus is a chronic disease associated with high complication rates; its incidence is increasing rapidly and it requires prompt, adequate treatment and care. Therefore, we investigated the quality of medical care provided to homeless diabetics in a general hospital and comorbidities associated with diabetes.
METHODS
Between March 25, 2011 and December 31, 2012, we retrospectively investigated the medical records of the diabetes patients at a general hospital in Seoul. We assigned the patients into two groups: homeless (n = 82) and non-homeless (n = 242) patients. We subsequently compared the clinical and laboratory findings, comorbidities, and complications between the two groups.
RESULTS
The homeless diabetics received treatment less regularly than the non-homeless patients and were diagnosed with diabetes while visiting the hospital for the treatment of other diseases. The homeless patients had higher glycated hemoglobin A1c levels than the non-homeless patients. The homeless patients had a higher rate of other diseases, such as peripheral artery disease, acute infectious disease, intracranial hemorrhage, and pulmonary tuberculosis; a higher incidence of acute infectious disease (odds ratio [OR], 15.671; 95% confidence interval [CI], 5.115-48.070); and a higher prevalence of pulmonary tuberculosis (OR, 6.423; 95% CI, 1.785-23.116) than the non-homeless patients, as determined by multivariate analysis.
CONCLUSIONS
Comorbid acute infectious disease and pulmonary tuberculosis were found more frequently in homeless diabetes patients presenting to the hospital than in non-homeless diabetes patients. Therefore, attention should be paid to this differentiating factor.

Keyword

Homeless persons; Diabetes mellitus; Tuberculosis, pulmonary

MeSH Terms

Chronic Disease
Communicable Diseases
Comorbidity*
Diabetes Mellitus
Hemoglobin A, Glycosylated
Homeless Persons
Hospitals, General*
Humans
Incidence
Intracranial Hemorrhages
Medical Records
Mortality
Multivariate Analysis
Peripheral Arterial Disease
Prevalence*
Retrospective Studies
Seoul
Tuberculosis, Pulmonary