Injury Patterns and Hospital Admission After Trauma Among People Experiencing Homelessness

Silver, Casey M; Thomas, Arielle; Reddy, Susheel; Sullivan, Gwyneth A.; Plevin, Rebecca; Kanzaria, Hemal K.; Stey, Anne M.

doi:10.1001/jamanetworkopen.2023.20862

Cited by 9 publications

(13 citation statements)

References 46 publications

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“…We assessed moderation effects of age and Injury Severity Score (ISS) on the association between homelessness and LOS. These variables were selected due to increasing age of the US homeless population and prior studies demonstrating differential associations between homelessness and hospital admission by ISS . Age was considered categorically (18-35, 36-50, 51-64, and ≥65 years), given the highly skewed distribution.…”

Section: Methodsmentioning

confidence: 99%

“…These variables were selected due to increasing age of the US homeless population and prior studies demonstrating differential associations between homelessness and hospital admission by ISS. 9,26 Age was considered categorically (18-35, 36-50, 51-64, and Ն65 years),…”

Section: Moderation Analysismentioning

confidence: 99%

“…[2][3][4][5] Structural barriers to accessing health care for people experiencing homelessness lead to high rates of emergency department use and hospitalization, resulting in significant health care costs. [6][7][8][9][10] Traumatic injury is the second leading reason for hospitalization among people experiencing homelessness. 11 A previous study 9 demonstrated that injured people experiencing homelessness are more likely to be admitted to the hospital than housed individuals.…”

Section: Introductionmentioning

confidence: 99%

“…[6][7][8][9][10] Traumatic injury is the second leading reason for hospitalization among people experiencing homelessness. 11 A previous study 9 demonstrated that injured people experiencing homelessness are more likely to be admitted to the hospital than housed individuals. However, little is known about their subsequent hospital course and the incidence of morbidity, surgical procedures, and intensive care unit (ICU) admissions.…”

Section: Introductionmentioning

confidence: 99%

“…People experiencing homelessness have worse health-related quality of life than housed individuals . Structural barriers to accessing health care for people experiencing homelessness lead to high rates of emergency department use and hospitalization, resulting in significant health care costs …”

Section: Introductionmentioning

confidence: 99%

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Morbidity and Length of Stay After Injury Among People Experiencing Homelessness in North America

Silver,

Thomas,

Reddy

et al. 2024

JAMA Netw Open

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ImportanceTraumatic injury is a leading cause of hospitalization among people experiencing homelessness. However, hospital course among this population is unknown.ObjectiveTo evaluate whether homelessness was associated with increased morbidity and length of stay (LOS) after hospitalization for traumatic injury and whether associations between homelessness and LOS were moderated by age and/or Injury Severity Score (ISS).Design, Setting, and ParticipantsThis retrospective cohort study of the American College of Surgeons Trauma Quality Programs (TQP) included patients 18 years or older who were hospitalized after an injury and discharged alive from 787 hospitals in North America from January 1, 2017, to December 31, 2018. People experiencing homelessness were propensity matched to housed patients for hospital, sex, insurance type, comorbidity, injury mechanism type, injury body region, and Glasgow Coma Scale score. Data were analyzed from February 1, 2022, to May 31, 2023.ExposuresPeople experiencing homelessness were identified using the TQP’s alternate home residence variable.Main Outcomes and MeasuresMorbidity, hemorrhage control surgery, and intensive care unit (ICU) admission were assessed. Associations between homelessness and LOS (in days) were tested with hierarchical multivariable negative bionomial regression. Moderation effects of age and ISS on the association between homelessness and LOS were evaluated with interaction terms.ResultsOf 1 441 982 patients (mean [SD] age, 55.1 [21.1] years; (822 491 [57.0%] men, 619 337 [43.0%] women, and 154 [0.01%] missing), 9065 (0.6%) were people experiencing homelessness. Unmatched people experiencing homelessness demonstrated higher rates of morbidity (221 [2.4%] vs 25 134 [1.8%]; P &lt; .001), hemorrhage control surgery (289 [3.2%] vs 20 331 [1.4%]; P &lt; .001), and ICU admission (2353 [26.0%] vs 307 714 [21.5%]; P &lt; .001) compared with housed patients. The matched cohort comprised 8665 pairs at 378 hospitals. Differences in rates of morbidity, hemorrhage control surgery, and ICU admission between people experiencing homelessness and matched housed patients were not statistically significant. The median unadjusted LOS was 5 (IQR, 3-10) days among people experiencing homelessness and 4 (IQR, 2-8) days among matched housed patients (P &lt; .001). People experiencing homelessness experienced a 22.1% longer adjusted LOS (incident rate ratio [IRR], 1.22 [95% CI, 1.19-1.25]). The greatest increase in adjusted LOS was observed among people experiencing homelessness who were 65 years or older (IRR, 1.42 [95% CI, 1.32-1.54]). People experiencing homelessness with minor injury (ISS, 1-8) had the greatest relative increase in adjusted LOS (IRR, 1.30 [95% CI, 1.25-1.35]) compared with people experiencing homelessness with severe injury (ISS ≥16; IRR, 1.14 [95% CI, 1.09-1.20]).Conclusions and RelevanceThe findings of this cohort study suggest that challenges in providing safe discharge to people experiencing homelessness after injury may lead to prolonged LOS. These findings underscore the need to reduce disparities in trauma outcomes and improve hospital resource use among people experiencing homelessness.

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Section: Methodsmentioning

confidence: 99%

Section: Moderation Analysismentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Morbidity and Length of Stay After Injury Among People Experiencing Homelessness in North America

Silver,

Thomas,

Reddy

et al. 2024

JAMA Netw Open

Self Cite

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Inpatient Care and Outcomes Among People With Cancer Experiencing Homelessness

Shah,

Santos,

Boe

et al. 2024

JAMA Oncol

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ImportanceCancer is a leading cause of death among people experiencing homelessness (PEH) in the US. Acute care settings are important sources of care for PEH; however, the association of housing status with inpatient care remains understudied, particularly in the context of cancer.ObjectiveTo assess whether housing status is associated with differences in the inpatient care of hospitalized adults with cancer.Design, Setting, and ParticipantsThis cross-sectional study included hospitalized inpatient adults aged 18 years or older diagnosed with cancer who were identified using data from the 2016 to 2020 National Inpatient Sample. Propensity score matching was used to create a cohort of PEH and housed individuals matched according to age, sex, race and ethnicity, insurance type, cancer diagnosis, number of comorbidities, substance use disorder, severity of illness, year of admission, hospital location, hospital ownership, region, and hospital bed size. Matched pairs were identified using a 1:1 nearest neighbor matching algorithm without replacement, accounting for survey weights. Data were analyzed from August 1, 2022, to April 30, 2024.ExposureHousing status.Main Outcomes and MeasuresThe associations of receipt of invasive procedures, systemic therapy, or radiotherapy during hospitalization (primary outcomes) as well as inpatient death, high cost of stay, and discharge against medical advice (AMA) (secondary outcomes) with housing status. Odds ratios and 95% CIs were estimated with multivariable logistic regression, with adjustment for patient, disease, and hospital characteristics of the matched cohort.ResultsThe unmatched cohort comprised 13 838 612 individuals (median [IQR] age, 67 [57-76] years; 7 329 473 males [53.0%]) and included 13 793 462 housed individuals (median [IQR] age, 68 [58-77] years) and 45 150 (median [IQR] age, 58 [52-64] years) individuals who were experiencing homelessness after accounting for survey weights. The PEH cohort had a higher prevalence of lung (17.3% vs 14.5%) and upper gastrointestinal (15.2% vs 10.5%) cancers, comorbid substance use disorder (70.2% vs 15.3%), and HIV (5.3% vs 0.5%). Despite having higher rates of moderate or major illness severity (80.1% vs 74.0%) and longer length of stay (≥5 days: 62.2% vs 49.1%), PEH were less likely to receive invasive procedures (adjusted odds ratio [AOR], 0.53; 95% CI, 0.49-0.56), receive systemic therapy (AOR, 0.73; 95% CI, 0.63-0.85), or have a higher-than-median cost of stay (AOR, 0.71; 95% CI, 0.65-0.77). Although PEH had lower rates of inpatient death (AOR, 0.79; 95% CI, 0.68-0.92), they were 4 times more likely to be discharged AMA (AOR, 4.29; 95% CI, 3.63-5.06).Conclusions and RelevanceIn this nationally representative cross-sectional study of hospitalized adults with cancer, disparities in inpatient care of PEH highlight opportunities to promote equitable cancer care in this socioeconomically vulnerable population.

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Outcomes and characteristics differ between homeless and housed trauma patients following the COVID-19 pandemic

Kovacs,

Cucher,

Thiessen

et al. 2024

Injury

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Injury Patterns and Hospital Admission After Trauma Among People Experiencing Homelessness

Cited by 9 publications

References 46 publications

Morbidity and Length of Stay After Injury Among People Experiencing Homelessness in North America

Morbidity and Length of Stay After Injury Among People Experiencing Homelessness in North America

Inpatient Care and Outcomes Among People With Cancer Experiencing Homelessness

Outcomes and characteristics differ between homeless and housed trauma patients following the COVID-19 pandemic

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