Homelessness, Race/Ethnicity, and Cardiovascular Disease: a State-of-the-Evidence Summary and Structured Review of Race/Ethnicity Reporting

In this review, we examine the intersection of cardiovascular disease (CVD), race/ethnicity, and homelessness/unstable housing—a key social determinant of cardiovascular health. Homelessness has deep roots reflecting structural racism in housing, educational, and economic policies, leading to disproportional representation of Black, Native American, and Hispanic people among the U.S. homeless population.

Increasingly rigorous observational studies detail the disproportionate incidence, prevalence, and mortality of CVD among people experiencing homelessness. Studies of hospital admissions document concerning disparities in procedural CVD care. We summarize current evidence about CVD among people experiencing homelessness. We conducted a new structured review of 27 articles about CVD and homelessness to determine if and how they collected and reported on race/ethnicity and racism. We searched for evidence-based interventions to improve CVD for people experiencing homelessness.

A recent systematic review and additional articles addressing CVD and homelessness found no interventions targeting the intersections of these topics or any that specifically addressed race/ethnicity. We found that 16 of 27 reviewed studies (59%) collected any data on race/ethnicity, but only 5 (19%) reported CVD-specific outcomes by race/ethnicity. We summarize clinical evidence based on expert opinion that, while practical, lacks rigor and does not consider the intersectional impact of race/ethnicity, homelessness, and other factors on people experiencing CVD. Therefore, we conclude that more research and innovation are needed using community-engaged approaches to develop evidence to support improved CVD prevention and management among people experiencing homelessness who identify as Black, Native American, Hispanic, or other people of color.