Differences in Cardiovascular Disease Burden, Screening, Education, and Care by Clinic Type in the 2022 Health Center Patient Survey

BackgroundPersons experiencing homelessness (PEH) have a 2-3-fold greater risk for cardiovascular disease (CVD) mortality compared with domiciled counterparts. Evidence has repeatedly shown elevated chronic disease burden, reduced access to many types of care, and lower utilization of medication to control CVD risk factors in clinical settings dedicated to providing health care to PEH. There are federally funded health clinics targeting barriers to access for patient populations experiencing homelessness in place. These clinics are frequently overwhelmed and limited by their scope to primary care despite well documented burdens of co- and tri-morbid conditions. There is scarce evidence on differences between access, quality, and experiences of care delivered relative to other safety-net models. MethodThe 2022 Health Center Patient Survey (HCPS) was collected on behalf of the Health Resources and Services Administration (HRSA). The HCPS is a nationally representative, three-staged, sample-based survey collected via 1:1 interview with clinic patients. The survey assessed sociodemographics, health conditions and behaviors, access to and utilization of care, and patients experiences with comprehensive services they received at HRSA-funded Federally Qualified Health Centers (FQHCs), including community health centers (CHC), healthcare for the homeless (HCH) clinics, and public housing primary care (PHPC) clinics. One hundred and three unique awardees and 318 health center sites were recruited, and 4,414 patient interviews were completed. Investigators analyzed patient characteristics and multiple survey items related to AHAs Essential 8 metrics for differences between HCH and CHC patient responses. ResultsHCH clinics had fewer elderly patients ([~]7%) than CHCs ([~]17%). Reported 7-day physical activity measures, average sleep below 7 hours per day, and Lifetime smoking (>100 cigarettes; OR=4.2, p<0.001) were all greatest among HCH patients. Fewer HCH patients reported ever having or recent lipid tests (both p<0.001). HCH patients were more likely to report hypertension (p=0.003) but less likely to report receiving nutrition advice (all p<0.05). HCH patients were less likely to be taking medication even if it was prescribed (p<0.001). Adjustments for differences in age or CVD history were able to explain some observed differences but increased the magnitude of other disparities. ConclusionsCVD burden differs across the various HRSA funding mechanisms for clinics, as do demographics and multiple metrics of health behaviors and biomarkers of cardiovascular health. Greater disease burden in HCH patients is likely compounded by increased risk factors and underperformance in providing health education interventions. Clinical PerspectiveO_ST_ABSWhat Is New?C_ST_ABSO_LIPatients accessing Health Care for the Homeless clinics demonstrate unique cardiovascular risk profiles characterized by higher rates of inadequate sleep, smoking history, and pre-diabetes compared to Community Health Center patients, even after adjusting for sociodemographic factors. C_LI What Are the Clinical Implications?O_LITraditional cardiovascular disease risk assessment tools and prevention strategies may need to be recalibrated for homeless populations, as standard clinical metrics and screening approaches may not fully capture the complex interplay of behavioral, environmental, and social exposures affecting this vulnerable group. C_LI Research PerspectiveO_ST_ABSWhat New Question Does This Study Raise?C_ST_ABSO_LIHow do structural inequities and comorbid conditions resulting in and from homelessness impact health in ways that may not be captured by conventional risk assessment tools? C_LI What Question Should be Addressed Next?O_LIWhat modifications to evidence-based cardiovascular interventions are needed to effectively serve people experiencing homelessness, and how can these interventions be integrated into Health Care for the Homeless clinics and other FQHCs? C_LI