Homelessness and health-related outcomes in the Republic of Ireland: a systematic review, meta-analysis and evidence map

Aim: To map existing research on homelessness and health in the Republic of Ireland, and to synthesize the evidence on housing-related disparities in health. Methods: Peer-reviewed articles and conference abstracts published in English between 2012–2022 were retrieved from 11 bibliographic databases if they contained empirical data on homelessness and health in Ireland, and – in a subsequent screening stage – at least one measure of health disparity between the homeless and general populations. Reviewers extracted relative risks (RR), 95% confidence intervals (CI), and calculated pooled RR of comparable health disparities using pairwise random-effects meta-analyses. Results: One hundred four articles contained empirical data on the health of homeless individuals residing in Ireland, addressing primarily substance use, addiction and mental health. Homelessness was associated with increased risk of illicit drug use (RR 7.33 [95% CI 4.2, 12.9]), reduced access to a general practitioner (GP) (RR 0.73 [CI 95% 0.71, 0.75]), frequent emergency department (ED) presentation (pooled RR 27.8 [95% CI 4.1, 189.8]), repeat presentation for self-harm (pooled RR 1.6 [95% CI 1.2, 2.0]) and premature departure from hospital (pooled RR 2.65 [95% CI 1.27, 5.53]). Conclusions: Homelessness in Ireland is associated with reduced access to primary care and overreliance on acute care. Chronic conditions amongst homeless individuals are understudied.