Chronic and Infectious Diseases in Homeless Populations

People experiencing homelessness face a dual burden of disease: a high prevalence of chronic non-communicable diseases and increased exposure to infectious conditions. These two categories often coexist and interact, creating complex and unstable health trajectories.

The interaction between unstable housing, poverty, stress, and fragmented healthcare access leads not only to higher disease prevalence, but also to poorer disease control and increased complications.

Chronic Diseases

Chronic diseases are among the leading causes of morbidity and mortality in homeless populations. Despite a younger average age, the burden of chronic illness resembles that of significantly older housed populations.

1. CARDIOVASCULAR DISEASES

2. DIABETES

3. RESPIRATORY DISORDERS

Highly prevalent cardiovascular conditions:

Hypertension

Ischaemic heart disease

Heart failure

Stroke

Contributing factors include:

Chronic stress and trauma

High smoking rates

Poor nutrition

Limited preventive screening

Untreated hypertension

Substance use

Stress associated with homelessness activates long-term neuroendocrine stress responses, contributing to elevated blood pressure and cardiovascular strain.

Poor access to regular primary care means hypertension often remains undiagnosed or poorly controlled. Acute cardiovascular events frequently present in emergency settings rather than being prevented through early management.

Diabetes management requires stability:

Regular meals

Blood glucose monitoring

Medication adherence

Safe storage of insulin

Predictable routines

These conditions are rarely available to people living in shelters, temporary accommodation, or on the street.

Challenges include:

Inability to refrigerate insulin

Irregular eating patterns

Missed medical appointments

Financial barriers to medication

As a result, complications such as neuropathy, kidney disease, retinopathy and diabetic emergencies are more common.

Poorly controlled diabetes increases vulnerability to infections and slows wound healing, further compounding risk.

Respiratory illnesses are common and often exacerbated by environmental exposure.

Common conditions include:

Chronic obstructive pulmonary disease (COPD)

Asthma

Chronic bronchitis

These conditions are rarely available to people living in shelters, temporary accommodation, or on the street.

Contributing factors:

High tobacco use

Exposure to cold and damp environments

Air pollution

Overcrowded shelters

Poor ventilation

Respiratory exacerbations frequently lead to emergency department visits. Without stable housing and regular inhaler use, long-term disease control remains difficult.

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