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Addressing Chronic Disease Burden and Healthcare Access Gaps in People Experiencing Homelessness: A Community-Based Study Through Osteopathic Medical Student-Led Interventions in Detroit

Journal: Journal of Osteopathic Medicine Date: 2025/12, 125(12):Pages: A741–743. doi: Subito , type of study: cross sectional study

Full text    (https://www.degruyterbrill.com/document/doi/10.1515/jom-2025-2000/html)

Keywords:

chronic pain [295]
cross sectional study [826]
health determinants [6]
homelessness [4]
medical students [644]
osteopathic medicine [2016]
underserved communities [4]
USA [1630]

Abstract:

Context: Chronic diseases such as hypertension, diabetes, and musculoskeletal disorders are among the leading causes of morbidity and mortality in the United States, accounting for 90% of the nation’s $4.5 trillion in annual healthcare costs. While national statistics describe high rates of these conditions in the general population, limited data describe how people experiencing homelessness (PEH) report and recognize their chronic illness burden (1). Individuals experiencing homelessness face significant barriers to healthcare access, with transportation identified as a critical social determinant of health (SDoH). In Detroit, where approximately 6,221 individuals are homeless, over 5.7% of adults are impacted by SdoH, such as a lack of reliable transportation, hindering access to medical appointments, and exacerbating chronic conditions (2). Existing literature highlights transportation challenges but lacks actionable data on how community-based interventions can address this gap in Detroit. Existing structural barriers, including low health literacy, stigmatization from the surrounding community, and inconsistent access to care, may lead to underrecognition and underreporting of chronic illnesses in this community, contributing to health disparities in this vulnerable population (3). Detroit Street Care (DSC), a student-led street medicine program at Michigan State University College of Osteopathic Medicine, provides free healthcare at shelters and soup kitchens, offering a unique platform to investigate SDoH barriers and train osteopathic medical students (OMS) in patient-centered care to address health disparities. This structure enables students in their early stages of the medical curriculum to learn from, recognize, and address SDoH. The current study hypothesizes that the gaps in health literacy impact observational studies of SDoH among PEH. In this sense, training medical students to conduct studies in these populations may enhance the students’ community-based research skills, as well as their ability to interpret and apply epidemiological data resulting from such studies. Objectives: 1)To assess osteopathic medical students’ understanding of social determinant of health (SdoH) through reflective practice training; 2) to evaluate the impact of a student-led intervention on healthcare access for PEH at DSC clinics; 3) to examine the prevalence of chronic conditions among PEH and 4) to assess PEH’s self-perception of chronic diseases their health literacy. Methods: This cross-sectional, community-based study recruited PEH or housing instability in Detroit, Michigan. Participants (N=48), older than 21 who visit soup kitchens with DSC volunteer presence (IRB: STUDY00010091), were verbally surveyed during visits at soup kitchens. OMS trained (N=18) in ethics and reflective practice conducted baseline and follow-up interviews addressing demographics, health status, access to healthcare, transportation barriers, missed appointments, and whether participants had chronic conditions. Follow-up questions asked what participants sought medical care for, which was used to identify additional chronic conditions not initially disclosed. Identified conditions were categorized into the following groups: musculoskeletal/orthopedic, cardiovascular/metabolic, pulmonary and neurological. Statistical analyses included descriptive statistics and a chi-square test (95% confidence interval, p<0.05) to compare appointment adherence rates between groups. Results: Of the 48 participants, only 40% self-reported chronic conditions; 66% experienced at least one chronic illness. Among those experiencing at least one chronic illness, a significantly higher (p<0.05) amount presented with musculoskeletal (44%) or cardiovascular/metabolic (41%), compared with pulmonary or neurological issues (9%). Among those reporting chronic illness, 38% experience more than one chronic disease affecting multiple physiological systems, which is significantly different (p<0.01) from those who actually experienced at least one chronic illness (66%). Conclusion: People experiencing homelessness (PEH) face a higher burden of chronic disease compared to the general population, yet they often lack adequate access to healthcare and may not recognize their need for care due to gaps in health literacy. Their underrecognition of their own chronic illness contributes to delayed diagnoses, suboptimal management, and ongoing health disparities. In contrast, the general population, comparatively experiencing a lower burden of chronic illness, benefits from more consistent healthcare access, further highlighting the urgent need to address these inequities. According to the 2024 CDC’s national data, approximately 60% of U.S. adults experience one chronic condition, with 40% reporting experiencing more than one chronic condition (4). Improving health education, removing systemic barriers, and promoting community-based outreach, such as those rooted in osteopathic medicine, are essential strategies to enhance health literacy, ensure continuity of care, and ultimately improve outcomes while reducing long-term healthcare consequences for this vulnerable population. This study highlights how osteopathic principles, such as whole-person care, emphasis on prevention, and attention to social determinants of health, can guide effective chronic disease detection and management among vulnerable populations. It also reinforces the integral role of street medicine and continuity-based care in addressing underdiagnosed chronic illness in unhoused individuals.


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