(Scientific Session) Musculoskeletal Disease Burden and Physical Function in Unhoused Adults Experiencing Homelessness

Background and/or Objectives: Describe physical functional impairment in adults experiencing homelessness. Analyze how exposure to years of homelessness relates to risk of moderate-severe functional impairment.

Design: Cross-sectional survey

Setting: Four homeless shelters in California

Participants: 200 adults residing in homeless shelters

Interventions: Not applicable

Main Outcome Measures: PROMIS Physical Function Short Form 10a instrument

Results: Participants were predominantly male (79%), had a median age of 47 (IQR 29-56) and reported a median of 8 years unhoused (IQR 3-15). Injuries and musculoskeletal diagnoses were common (lifetime fracture 69%, dislocated joint 40%, torn ligament/tendon 33%, diagnosed arthritis 21%, diagnosed spinal deformity/problem 15%). Most participants had PROMIS scores indicating mild (18%), moderate (32%), and severe (5%) physical functional impairment. Some participants reported that their musculoskeletal injury or disease prevented them from finding/keeping employment (26%) or housing (12%). In multivariable analysis, each additional year of homelessness was associated with significantly higher risk of moderate-severe functional impairment (Adjusted risk difference per year: 0.6%, CI 0.1, 1.2%) when controlling for age (ARD per year: 0.2% CI -0.1,0.6%), female sex (ARD 20%, CI 4, 36%), history of major musculoskeletal injury (ARD 20%, CI 5, 34%), diagnosed arthritis (ARD 27%, CI 9, 44%), diagnosed spinal problem (ARD 16%, CI -2, 34%), usual occupation that involved heavy machinery (ARD 16%, CI 1, 30%), and any diagnosed substance use disorder (ARD 5%, CI -8, 17%).

Conclusions: The adults experiencing homelessness that we surveyed had a higher prevalence of physical functional impairment than the general population. Each additional year of homelessness significantly increased risk of moderate-severe physical functional impairment independent of age, sex, workplace exposures, substance use, and lifetime musculoskeletal injuries/diagnoses. This suggests that the longer an individual experiences homelessness, the greater burden of functional impairment they will accrue, making it harder to find accessible employment and housing.