Introduction: Homelessness is associated with a higher burden of vascular risk factors and an increased risk of stroke. However, its specific impact on acute stroke care and outcomes remains poorly understood. In this study, we conducted a systematic review and meta-analysis to compile the available evidence. Methods: We searched PubMed, EMBASE, PsycINFO, Scopus, and Web of Science from 2000 to 2024 without language restrictions. Original observational studies of adults with acute stroke (ischemic or hemorrhagic) experiencing homelessness were included. Animal studies, studies in children, and studies without clear characterization of housing status and stroke outcomes were excluded. We compared post-stroke mortality, use of acute cerebrovascular diagnostics and therapeutics (including intravenous thrombolysis IVT, mechanical thrombectomy, and vessel imaging), discharge destinations, and mean length of hospital stay between patients experiencing homelessness (PEH) and housed patients. Results: Titles and abstracts of 1,598 articles were screened by two independent reviewers, and 80 studies were selected for full-text review. Seven studies comprising 620,327 patients experiencing homelessness and 3,035,234 housed patients were included in the systematic review. All seven studies were rated as moderate to high quality. Pooled analysis demonstrated 43% higher risk of post-stroke mortality among PEH (odds ratio OR 1.43; 95% confidence interval CI 1.34–1.53). PEH with ischemic stroke had lower odds of receiving IVT compared to housed individuals (OR 0.87; 95% CI 0.79–0.96). Two studies reported on discharge destinations, both indicating that PEH were more likely to be discharged to self-care or leave against medical advice. Discussion: Patients experiencing homelessness are at increased risk for post-stroke mortality, and they are less likely to receive intravenous thrombolytics. Available evidence suggests that they are also more frequently discharged without support. Further research is needed to identify strategies and address disparities in post-stroke care to improve outcomes in this underserved population.
McKay et al. (Thu,) studied this question.