## 4 Discussion  
Over the last decade, the number of people living in disadvantaged conditions in Italy has increased, posing a considerable problem in terms of disease screening, diagnosis, and treatment. As known, this population is highly vulnerable to a variety of health problems, often having sudden onsets, demanding long hospital stays, and resulting in higher death rates when compared to the general population [20; 21; 22; 23]. In this study, we examined through unstructured interviews and general health assessment the conditions of 436 participants who lived in socioeconomically disadvantaged neighborhoods, with the help of general practitioners and specialized doctors that reached them in their living settings. From a clinical standpoint, the main health parameters were measured and focused on the presence or absence of both acute and/or chronic diseases, as well as data pertaining to COVID-19. From a demographic point of view, the subjects included in this type of study tend to display comparable characteristics. The majority are often males aged 20 to 70 years, with an average age of 40 to 50 years [27; 28; 29; 30]. Most individuals live in shelters or were, indeed, not homeless; most participants were living in dormitories at the time of the interview, whereas others lived in owned, rented, or squatted houses. In terms of employment, only a few had a job, and even fewer had stable ones; the majority were indeed unemployed, thus affecting the personal perception of health [28; 31]. Smoking-related deaths, particularly lung cancer-related deaths, are common in the homeless community [32; 33]. As indicated in most studies on the matter, the smoking habits of this demographic group differ from those of the general population and are characterized by a greater consumption of tobacco [34; 35; 36; 37]. COPD and respiratory tract infections are also frequent medical problems in disadvantaged populations [38; 39]. In our study cohort, a portion of the patients reported having some type of respiratory/pulmonary illness, such as asthma, COPD, respiratory infections, respiratory failure, and bronchitis/pneumonia. Due to crowded shelter conditions, these subjects are also at an increased risk of contracting tuberculosis and, during the COVID-19 pandemic, were at higher risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) contagion [40; 41]. A significant percentage of our sample reported alcohol use. As known, the homeless community comprises individuals who frequently suffer from advanced alcoholism, which is often used as a coping mechanism, and which negatively impacts participation in support programs. A study conducted on 78 homeless adults found that 75% matched the alcohol dependence criterion, with significant connections between age, preferred coping strategy, and amount of alcohol consumption [27; 28; 30; 42; 43; 44]. During the general health assessment, both vital signs and blood glucose levels were assessed. Blood pressure readings showed a prevalence of systolic measurements between 121 and 130 mmHg, with only a few patients displaying values \(\geq 180\). In terms of diastolic pressure, many participants exhibited values \(\leq 85\) mmHg, whereas eight displayed grade 2 hypertension (160-179/100-109 mmHg) and four displayed grade 3 hypertension (180/110 mmHg). According to the literature, disadvantaged communities are especially prone to hypertension for a variety of reasons [45; 46; 47; 48], with a significant risk of displaying cardiovascular events and strokes. A study conducted on 390 homeless adults showed that more than half (average age, 51 years) suffered from this pathology, with a total prevalence of 61.52% [43]. On the contrary, in a study by [PERSON] et al. [28], hypertension was detected in 35% of patients, with less than a third of the subjects being aware of the condition; the lack of awareness could possibly be related to the often-vague symptoms characterizing this condition. Heart attacks and strokes, on the other hand, tend to be more frequently reported.