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Because they usually lack health insurance, homeless persons tend not to get adequate preventive care and appropriate routine management of such chronic illnesses as hypertension, heart disease, diabetes, and emphysema. They tend to visit emergency rooms for acute illnesses. Besides lack of health insurance, other barriers to care include denial of health problems; the pressure to fulfill competing nonfinancial needs, such as those for food, clothing, and temporary shelter; and misconceptions, prejudices, and frustrations on the part of health professionals. When hospitalized, the average length of stay of a homeless individual, in 1 study, was 4.1 days, or 36% longer than that of low-income, non-homeless individuals, even after adjustment for differences in the rates of substance abuse and mental illness and other clinical and demographic characteristics. The cost of the additional hospital days per discharge ranged from $2414 to $4094 (1992-1993 dollars).
Homeless adults have an age-adjusted mortality rate nearly 4 times that of the general population; their average life span is shorter than 45 years. Homeless women 18 to 44 years of age are between 5 and 31 times more likely to die than women in the general population. Homeless women older than age 44 are only 1 to 2 times as likely to die, and are healthier than their male counterparts. However, homeless women in their mid-fifties are as physiologically aged as housed women in their seventies and are afflicted to a similar degree with chronic diseases, yet they do not qualify for elderly housing assistance.