Sick and unsheltered: Homelessness as a major risk factor for emergency care utilization

• Published in: The American journal of emergency medicine Vol. 37; no. 3; pp. 415 - 420
• Main Authors: Amato, Stas, Nobay, Flavia, Amato, David Petty, Abar, Beau, Adler, David
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2019; Elsevier Limited
• Subjects: Age; Alcohol; Confidence intervals; Demographics; Demography; Drug abuse; Drug overdose; Electronic medical records; Emergency care; Emergency medical care; Emergency medical services; Emergency services; Epidemics; Ethnicity; Government programs; Health care facilities; Health care policy; Health services utilization; Homeless people; Homelessness; Injuries; Life expectancy; Life span; Minority & ethnic groups; Mortality; Multivariate analysis; Pain; Public health; Risk factors; Sex crimes; Social work; Socioeconomic factors; Homelessness; Emergency care; Health services utilization; Public health
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2018.06.001

Homelessness is a critical public health issue and socioeconomic epidemic associated with a disproportionate burden of disease and significant decrease in life expectancy. We compared emergency care utilization between individuals with documented homelessness to those enrolled in Medicaid without documented homelessness. We conducted a retrospective cohort study consisting of electronic medical record review of demographics, chief complaints, and health care utilization metrics of adults with homelessness compared to a group enrolled in Medicaid without identified homelessness. The chart review spanned two years of emergency visits at a single urban, academic, tertiary care medical center. Descriptive statistics, bivariate and multivariate analyses were utilized. Over the study period, 986 patients experiencing homelessness accounted for 7532 ED visits, with a mean of 7.6 (SD 19.9) and max of 316 visits. The control group of 3482 Medicaid patients had 5477 ED visits, with a mean of 1.6 visits (SD 2.1) and max of 49 visits. When controlling for age, sex, race, ethnicity, and ESI, those living with homelessness were 7.65 times more likely to return to the ED within 30 days of their previous visit, 9.97 times more likely to return within 6 months, 10.63 times more likely to return within one year, and 11 times more likely to return within 2 years. Compared to non-homeless Medicaid patients, patients with documented homelessness were over seven times more likely to return to the ED within 30 days and over eleven times more likely to return to the ED in two years.