Disparities in diabetes processes of care among people experiencing homelessness: An opportunity for intervention

Aims

To compare processes of diabetes care by homeless status.

Methods

A population-based propensity matched cohort study was conducted in Ontario, Canada. People with diabetes were identified in administrative healthcare data between April 2006 and March 2019. Those with a documented history of homelessness were matched to non-homeless controls. Data on processes of care measures included glucose monitoring tests, screening for microvascular complications, and physician follow-up. Differences in processes of care were compared by homeless status using proportions, risk ratios, and rate ratios.

Results

Of the 1,076,437 people with diabetes, 5219 matched pairs were identified. Homelessness was associated with fewer tests for glycated hemoglobin (RR = 0.63; 95 %CI: 0.60–0.67), LDL cholesterol (RR = 0.80; 95 %CI: 0.78–0.82), serum creatinine (RR = 0.94; 95 %CI: 0.92–0.97), urine protein quantification (RR = 0.62; 95 %CI: 0.59–0.66), and eye examinations (RR = 0.74; 95 %CI: 0.71–0.77). People with a history of homelessness were less likely to use primary care for diabetes management (RR = 0.62; 95 %CI: 0.59–0.66) or specialist care (RR = 0.87; 95 %CI: 0.83–0.91) compared to non-homeless controls.

Conclusions

Disparities in diabetes care are evident for people with a history of homelessness and contribute to excess morbidity in this population. These data provide an impetus for investment in tailored interventions to improve healthcare equity and prevent long-term complications.