Correlates of Hospital Use in Homeless and Unstably Housed Women: The Role of Physical Health and Pain

Abstract

Purpose To examine correlates of emergency department (ED) use and hospitalizations in a community-based cohort of homeless and unstably housed women, with a focus on the role of physical health and pain. Methods We conducted a cross-sectional analysis of baseline survey results from a study of homeless and unstably housed women in San Francisco. Primary outcomes were any self-reported ED visit and inpatient hospitalization over the prior 6 months. Primary independent variables of interest were self-reported physical health status, as measured by the Short Form-12 (SF-12), and bodily pain. Other potential covariates were organized using the Gelberg-Andersen Behavioral Model for Vulnerable Populations. Standard bivariate and multivariable logistic regression techniques were used. Results Three hundred homeless and unstably housed women were included in the study, of whom 37.7% reported having an ED visit and 23.0% reported being hospitalized in the prior 6 months. Mean SF-12 physical health scores indicated poorer than average health compared to the U.S. norm. Most women (79.3%) reported at least some limitation in their daily activities due to pain. In adjusted analyses, moderate and high levels of bodily pain were significantly correlated with ED visits (OR=2.92 and OR=2.57) and hospitalizations (OR=6.13 and OR=2.49). As SF-12 physical health scores decreased, indicating worse health, the odds of ED use increased. Predisposing, enabling and additional need factors did not mediate these associations. Conclusions Physical health and bodily pain are important correlates of ED visits and hospitalizations in homeless and unstably housed women. Interventions to reduce ED use among women who are homeless should address the high levels of pain in this population.

Risk factors for stimulant use among homeless and unstably housed adult women

“…This remarkably high level of violence against impoverished women is consistent with studies in multiple geographic areas (Bonugli et al, 2013; Bourgois et al, 2004; Galano et al, 2013; Riley et al, 2014; Tutty et al, 2013; Wenzel et al, 2006), suggesting the ongoing recognition of this public health problem and the lack of an effectual response. Results presented here and elsewhere suggest that continued violence against impoverished women not only compromises health and increases emergency department use (Doran et al, 2014), it also increases the risk of subsequent drug use (ARR = 4.56; 95% CI: 1.93–10.76; Table 2) and increases the severity of addiction (Fernandez-Montalvo et al, 2014a). …”

Public Housing Relocations and Relationships of Changes in Neighborhood Disadvantage and Transportation Access to Unmet Need for Medical Care

“…42 The G-AMVP has been used successfully to describe predisposing, enabling , and need predictors of health care utilization among precariously housed populations and substance users in the U.S. 43–46 Predisposing characteristics include individual-level factors that exist prior to the perception of illness, including sociodemographic characteristics (e.g., gender) and variables that reflect vulnerability, such as housing. Need includes factors that may initiate health care seeking, such as perceived health status.…”

Correction

“…People who are homeless are also at increased risk for premature death and contracting tuberculosis (Hwang, 2001). Being homeless is associated with pain and increased visits to emergency rooms (Doran et al, 2014). Thus, IPV resulting in homelessness has multiple psychological as well as medical consequences (Elsevier Health, 2014).…”