TY - JOUR
T1 - Trends, Causes, and Outcomes of Hospitalizations for Homeless Individuals
AU - Wadhera, Rishi K.
AU - Choi, Eunhee
AU - Shen, Changyu
AU - Yeh, Robert W.
AU - Joynt Maddox, Karen E.
N1 - Funding Information:
R.K.W. is supported by National Institutes of Health Training Grant T32HL007604-32, Brigham and Women’s Hospital, Division of Car-diovascular Medicine. K.E.J.M. receives research support from the Na-tional Heart, Lung, and Blood Institute (K23HL109177-03). R.W.Y. receives research support from the National Heart, Lung and Blood In-stitute (R01HL136708) and the Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology.
Publisher Copyright:
© Copyright 2018 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2019/1/1
Y1 - 2019/1/1
N2 - Objectives: In the United States, an estimated 553,000 people are homeless on any given night. Few data provide large-scale, contemporary insight with regard to recent patterns of acute illness in this vulnerable population. We evaluated patterns, causes, and outcomes of acute hospitalization among homeless persons compared with a demographics-standardized and risk-standardized nonhomeless cohort. Methods: Retrospective study comparing 185,292 hospitalizations for homeless individuals and 32,322,569 hospitalizations for demographics-standardized nonhomeless individuals between 2007 and 2013 in Massachusetts, Florida, and California. Annual hospitalization rates for homeless persons were calculated and causes of hospitalization were compared with a demographics-standardized nonhomeless cohort. Logistic and linear regression models were used to estimate risk-standardized outcomes. Results: From 2007 to 2013, hospitalizations for the homeless increased in Massachusetts (294 to 420 hospitalizations per 1000 homeless residents), Florida (161 to 240/1000), and California (133 to 164/1000). Homeless patients were on average 46 years of age, often male (76.1%), white (62%), and either uninsured (41.9%) or insured by Medicaid (31.7%). Hospitalizations for homeless persons, compared with demographics-standardized nonhomeless, were more frequently for mental illness and substance use disorder (52% vs. 18%, P<0.001). Homeless compared with risk-standardized nonhomeless individuals had lower in-hospital mortality rates (0.9% vs. 1.2%, P<0.001), longer mean length of stay (6.5 vs. 5.9 d, P<0.001), and lower mean costs per day ($1 535 vs. $1 834, P<0.001). Conclusions: Hospitalizations among homeless persons are rising. Despite greater policy and public health focus over the last few decades, mental illness and substance use remain primary drivers of acute hospitalization among homeless adults. Policy efforts should address barriers to the use of ambulatory care services, and behavioral health services in particular, to help reduce acute care use and improve the long-Term health of homeless individuals.
AB - Objectives: In the United States, an estimated 553,000 people are homeless on any given night. Few data provide large-scale, contemporary insight with regard to recent patterns of acute illness in this vulnerable population. We evaluated patterns, causes, and outcomes of acute hospitalization among homeless persons compared with a demographics-standardized and risk-standardized nonhomeless cohort. Methods: Retrospective study comparing 185,292 hospitalizations for homeless individuals and 32,322,569 hospitalizations for demographics-standardized nonhomeless individuals between 2007 and 2013 in Massachusetts, Florida, and California. Annual hospitalization rates for homeless persons were calculated and causes of hospitalization were compared with a demographics-standardized nonhomeless cohort. Logistic and linear regression models were used to estimate risk-standardized outcomes. Results: From 2007 to 2013, hospitalizations for the homeless increased in Massachusetts (294 to 420 hospitalizations per 1000 homeless residents), Florida (161 to 240/1000), and California (133 to 164/1000). Homeless patients were on average 46 years of age, often male (76.1%), white (62%), and either uninsured (41.9%) or insured by Medicaid (31.7%). Hospitalizations for homeless persons, compared with demographics-standardized nonhomeless, were more frequently for mental illness and substance use disorder (52% vs. 18%, P<0.001). Homeless compared with risk-standardized nonhomeless individuals had lower in-hospital mortality rates (0.9% vs. 1.2%, P<0.001), longer mean length of stay (6.5 vs. 5.9 d, P<0.001), and lower mean costs per day ($1 535 vs. $1 834, P<0.001). Conclusions: Hospitalizations among homeless persons are rising. Despite greater policy and public health focus over the last few decades, mental illness and substance use remain primary drivers of acute hospitalization among homeless adults. Policy efforts should address barriers to the use of ambulatory care services, and behavioral health services in particular, to help reduce acute care use and improve the long-Term health of homeless individuals.
KW - Homeless persons
KW - affordable care act
KW - health disparities
KW - health outcomes
KW - homelessness
KW - public health
KW - vulnerable populations
UR - http://www.scopus.com/inward/record.url?scp=85057247573&partnerID=8YFLogxK
U2 - 10.1097/MLR.0000000000001015
DO - 10.1097/MLR.0000000000001015
M3 - Article
C2 - 30461584
AN - SCOPUS:85057247573
VL - 57
SP - 21
EP - 27
JO - Medical Care
JF - Medical Care
SN - 0025-7079
IS - 1
ER -