Homelessness and self-rated health: findings from a cross-sectional study of people experiencing homelessness in the city of Warsaw, Poland

Background
People experiencing homelessness (PEH) exhibit poorer health outcomes, shorter life expectancy, and lower self-rated health (SRH) compared to the average population. SRH, a single-item measure of health status, is a valid predictor of current health and future morbidity and mortality. Unfortunately, the health perceptions and health-related needs of PEH remain largely under-researched.

Objectives
This study aims to deepen the understanding of PEH health perceptions and identify the factors contributing to negative SRH within this marginalized population.

Material and methods
A cross-sectional survey was conducted among PEH using a structured questionnaire to investigate SRH and its determinants. Multiple logistic regression analysis was performed to examine the relationship between individual characteristics and negative SRH among PEH.

Results
Among the 200 PEH who participated in the study, two-thirds (66.0%) were categorized as roofless according to the European Typology of Homelessness and Housing Exclusion (ETHOS). 42 (21.0%) individuals rated their health as poor or very poor. The risk of negative SRH was statistically significantly increased by having only primary education (OR = 2.726 [1.120–6.638], p = 0.027) and reporting health problems lasting at least 6 months (OR = 9.289 [3.736–23.097], p < 0.001). In contrast, being 40–49 years of age was associated with a reduced risk of negative self-perception of health (OR = 0.092 [0.020–0.411], p = 0.002). None of the homelessness-related factors were predictors of negative self-perception of health.

Conclusions
Homelessness harms health and worsens health inequities. Identifying factors affecting PEH’s SRH can guide health and social workers in planning and prioritizing interventions, promoting health equity, and improving access to care for this vulnerable population.