Association of Substance use Characteristics and Future Homelessness among Emergency Department Patients with Drug use or Unhealthy Alcohol Use: Results from a Linked Data Longitudinal Cohort Analysis

Abstract

Background: Homelessness and substance use are intricately related, and both are prevalent among emergency department (ED) patients. This study examined the longitudinal association of substance use characteristics with future homeless shelter entry among ED patients with any drug use or unhealthy alcohol use. Methods: We present results from a longitudinal cohort study of public hospital ED patients who screened positive for drug use or unhealthy alcohol use and who were not homeless at their baseline (index) ED visit. The primary outcome was homeless shelter entry within 12 months of baseline, ascertained in city homeless shelter administrative data. Primary independent variables of interest were alcohol use severity (AUDIT), drug use severity (DAST-10), and types of drugs used, as reported on baseline survey questionnaires. Results:Analyses included 1,210 ED patients. By 12 months following the baseline ED visit, 114 (9.4%) had entered a homeless shelter. Among patients with the most severe problems related to drug use (DAST-10 score 9–10), 40.9% entered a shelter within 12 months. Past shelter use was the strongest predictor of future shelter entry; once adjusting for historic shelter use the relationship of AUDIT and DAST-10 scores with future shelter entry was no longer statistically significant in multivariable models. Conclusions: ED patients with past year drug use or unhealthy alcohol use had relatively high likelihood of future shelter entry. Risk for homelessness should be addressed in future interventions with this population. Findings illustrate the complexity of relationships between substance use and homelessness.

ED‐Home: Pilot feasibility study of a targeted homelessness prevention intervention for emergency department patients with drug or unhealthy alcohol use

“…45 Our pilot study focused on the subpopulation of ED patients with drug and unhealthy alcohol use; these factors confer additional individual risk beyond the primary structural drivers of homelessness (i.e., lack of affordable housing). 19 Brief interventions for substance use have become increasingly common in EDs, [46][47][48]…”

“…Unstably housed ED patients may not access traditional social service sites, making EDs promising points of intervention to identify unstable housing and intervene to prevent downstream homelessness. 17,18 This promise is heightened given the bidirectional relationship between homelessness and substance use 19,20 and the high prevalence of drug and unhealthy alcohol use among ED patients. To our knowledge, however, no prior research has examined interventions to prevent homelessness among ED patients.…”

Risk Assessment and Predicting Homelessness and Police Interaction in Calgary Through Administrative Health Care Data

“…Since people with mental illness are more likely to experience homelessness and encounters with the police, it is important to study the factors that are associated with these adverse outcomes. Additionally, many studies looked at the features associated with homelessness and police interaction, such as previous arrests (14) or previous use of emergency homeless shelters (15). But, these studies did not investigate the initial occurrence of these outcomes (16).…”

Revisión bibliográfica sobre la Vulnerabilidad Social y los procesos de hospitalización: una mirada desde el Trabajo Social sanitario.

“…Estos estudios muestran que la vulnerabilidad social implica un descenso de las posibilidades de las personas para disfrutar de un estado de salud óptimo (salud definida como bienestar y como derecho), convirtiéndose en una variable a tener en cuenta en la investigación clínica y en la gestión de recursos sanitarios. Se han establecido comunidades y grupos vulnerables frente a diferentes enfermedades (Farooqi et al, 2022;Kaplan & Leitman, 2022;Walls et al, 2022;Yoo et al, 2022) con el objetivo de minimizar el riesgo de inequidad sanitaria, pero es difícil encontrar estudios que analicen y sistematicen las características individuales de las personas usuarias frente a los factores sociales que integran el estado de vulnerabilidad. Si bien es importante poder valorar la vulnerabilidad social en todos los ámbitos de la sanidad, en los hospitales es de vital importancia, ya que los riesgos sociales no abordados entre pacientes hospitalizados con condiciones agudas y crónicas contribuyen a complicaciones costosas, a hospitalizaciones previsibles (Phillips et al, 2020), reingresos hospitalarios (Hughes et al, 2022) y una mayor tasa de mortalidad (Lipshutz et al, 2022).…”