SynthesisJournal of epidemiology and community health2021
Health of people experiencing co-occurring homelessness, imprisonment, substance use, sex work and/or severe mental illness in high-income countries: a systematic review and meta-analysis.
Synthesis in Journal of epidemiology and community health, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 38 papers, 6 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
38 citing papers in PubMed, 6 syntheses or guidelines pooled it.
- Incidence of physical non-communicable disease in people who have experienced imprisonment compared with the general population in high-income countries: a systematic review and meta-analysis.Journal of epidemiology and community health · 2026Pooled it
- Effectiveness of psychosocial interventions for adults with substance use disorder that have a co-occurring mental health disorder: an umbrella review and illustrative cost-effectiveness analysis.Health technology assessment (Winchester, England) · 2026Pooled it
- Predictors and consequences of homelessness in whole-population observational studies that used administrative data: a systematic review.BMC public health · 2023Pooled it
- Does paraspinal muscle morphometry predict functional status and re-operation after lumbar spinal surgery? A systematic review and meta-analysis.European radiology · 2023Pooled it
- Epidemiology of injecting drug use, prevalence of injecting-related harm, and exposure to behavioural and environmental risks among people who inject drugs: a systematic review.The Lancet. Global health · 2023Pooled it
- Homelessness and health-related outcomes: an umbrella review of observational studies and randomized controlled trials.BMC medicine · 2022Pooled it
- Trial
- Article
- From Stigma to Recognition in Dual Diagnosis Care: A Multilevel Conceptual Framework.Community mental health journal · 2026Article
- Associations Between Violence and Psychological Distress Among Women Experiencing Homelessness: A Cross-Sectional Study.Violence against women · 2026Article
- Incorporating a Veteran's lived and living expertise of sex work and substance use into clinician education.BMC medical education · 2026Article
- Article
- How to Better Screen for Blood-Borne Viruses, Specifically HIV, in Hospital Emergency Departments: French and European Perspectives.Infectious diseases and therapy · 2026Review
- Article
- Article
- Organising housing and service provision for persons with co-occurring substance use and mental health problems: a scoping review in the ROP Municipal.BMC psychiatry · 2025Article
- Risk factors and predictive performance for first healthcare encounter indicating homelessness using administrative data among Calgary residents diagnosed with addiction or mental health conditions.PLOS digital health · 2025Article
- Implementing trauma-informed practice across services to support people experiencing multiple disadvantage: a mixed method study.BMC health services research · 2025Article
- Improving the reporting on health equity in observational research (STROBE-Equity): extension checklist and elaboration.BMJ (Clinical research ed.) · 2025Article
- Exploring HIV Risk Among Sexual Minority Women by Identity and Behavior in a Population-Based Sample of Low-Income Heterosexually Active Women.LGBT health · 2025Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
12 authors.
Funding
Abstract
backgroundPeople affected by homelessness, imprisonment, substance use, sex work or severe mental illness experience substantial excess ill health and premature death. Though these experiences often co-occur, health outcomes associated with their overlap have not previously been reviewed. We synthesised existing evidence on mortality, morbidity, self-rated health and quality of life among people affected by more than one of these experiences.
methodsIn this systematic review and meta-analysis, we searched Medline, Embase, and PsycINFO for peer-reviewed English-language observational studies from high-income countries published between 1 January 1998 and 11 June 2018. Two authors undertook independent screening, with risk of bias assessed using a modified Newcastle-Ottawa Scale. Findings were summarised by narrative synthesis and random-effect meta-analysis.
resultsFrom 15 976 citations, 2517 studies underwent full-text screening, and 444 were included. The most common exposure combinations were imprisonment/substance use (31% of data points) and severe mental illness/substance use (27%); only 1% reported outcomes associated with more than two exposures. Infections were the most common outcomes studied, with blood-borne viruses accounting for 31% of all data points. Multiple exposures were associated with poorer outcomes in 80% of data points included (sign test for effect direction, p<0.001). Meta-analysis suggested increased all-cause mortality among people with multiple versus fewer exposures (HR: 1.57 and 95% CI: 1.38 to 1.77), though heterogeneity was high.
conclusionPeople affected by multiple exclusionary processes experience profound health inequalities, though there are important gaps in the research landscape. Addressing the health needs of these populations is likely to require co-ordinated action across multiple sectors, such as healthcare, criminal justice, drug treatment, housing and social security. PROSPERO REGISTRATION NUMBER: CRD42018097189.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.