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Analysis of the "Charity hospital" database

Authors:

  • Ekaterina Fokina
  • Eugene Potapenko
  • Mariia Firuleva
  • Liliya Golubnikova

Introduction

The Charity Hospital is a non-profit organization that provides comprehensive medical and social assistance to the homeless, migrants, refugees, and people without documents and citizenship since 2018.

Data was recorded and managed with the REDCap system, a secure, web-based application designed to support data capture for research studies. The REDCap system is collecting data on every homeless patient who seeks medical help. This is a unique practice for Russia and the analysis of the collected data (1633 unique patients) will help to improve service for homeless people in protecting their health.

Aim, tasks and data

The aim of this project was to perform the database analysis and identify the patterns in the incidence (morbidity) of homeless patients.

Tasks:

  1. describe the portrait of a homeless patient
  2. determine the influence of the place of sleeping on the presence of any disease
  3. cluster homeless patients by places of assistance and identify specific charactercistics of these clusters (health and socio-economic indicators)
  4. identify the relationship between calling an ambulance (AMS) and the state of the homeless patient, build a predictive model for calling an ambulance

Results

The portrait of a homeless patient

Age and gender

Citizenship

Documents

Family status and education

The most common diseases of the homeless people

DS-ICD №10 disease categories

Social diseases

  • HIV

  • Hepatit B, C, lues

The categories of homeless people by place of sleeping

Here you can see statistic distribution of the homeless people among place of sleeping at their first and last visit:

We analyzed how changed the conditions of living of the Charity Hospital patients.

Conclusion: The number of patients whose place of living has improved is only 43 (2.6%).
At the same time, the number of patients whose place of living became worse was 55 (3.4%).

Categories of homeless people

For the further analysis we grouped patients by places of living in the following categories:

  • Chronic Homelessness (street)
  • Hidden Homelessness (conditional)
  • Domestic Homelessness

The influence of the place of sleeping on the presence of any disease

Here we analyzed the distribution of DS-ICD №10 disease categories, socially significant infections (hepatit B, C, syphilis, HIV), alcohol addictions, tuberculosis among different categories of homeless people. In addition we calculated multiple Chi-square test for some pairs with statistically relevant number of observations (not less than 30).

Categories of homeless people and DS-ICD №10 disease categories

Multiple Chi-square test
Hypothesis: Is the distribution of ICD-10 among different categories of homelessness non-random.
Adjusted p-value = 0.003

Revealed dependency: Disease of the circulatory system, I00-I99 (p-value = 0.000284)

Categories of homeless people and tuberculosis

Categories of homeless people and addictions
Multiple Chi-square test
Hypothesis: There is an association between the type of homelessness and the presence of addiction.
Conclusion: Alcohol addiction is associated with a type of homelessness (p-value = 1.21e-08).

Adjusted p-value = 0.0125

The categories of homeless patients by places of assistance and test of independence

Here we grouped places of assistance according with international categories: parking, shelter, night shelter, remote consultation, heating point, medical center.

Places of assistance and DS-ICD №10 disease categories

Conclusion: most visits of patients were at the parking places, so neither factor showed the significance different between different places of assistance.

Summary

  1. Mostly men apply for medical assistance to the Hospital. The number of male patients is 3.5 times higher than female patients. The predominant age group is 45-59 years old, the category of homelessness is hidden. The average number of visits per year is 2.4.

  2. The most common reason for seeking medical attention is injury (S00-T98), disease of the musculoskeletal system and connective tissue (M0-M99), disease of the skin and subcutaneous tissue (L55-L59), disease of the circulatory system (I00-I99), diseases of the digestive system (K00-K93), respiratory diseases (J00-J99).

  3. Alcohol addiction is associated with a type of homelessness. A relationship was also found between alcohol dependence and diseases of the circulatory system (I00-I99), diseases of the skin and subcutaneous tissue (L55-L59).

  4. The relationship between the disease of the circulatory system (I00-I99) and the categories of homelessness was revealed.

  5. It was found that people who were in prison are more likely to suffer from alcohol addiction.

  6. It is also worth noting the high prevalence of diabetes mellitus, HIV among the homeless compared to the population of the Russian Federation.

  7. Living conditions (category of homelessness) worsened in a larger percentage of participants during the year.

References