The effect of homelessness on hospitalisation among patients with HIV/AIDS

Abstract

The purpose of this study was to determine the effect of homelessness on the costs and patterns of hospitalisation in patients with HIV/AIDS. A retrospective longitudinal study design, based on medical records data covering 2,768 person-years of observation between 1997 and 2003 on patients with HIV/AIDS, was employed. A contextual measure of neighbourhood socioeconomic status (SES) was also used to uncover differences among low- and high-SES neighbourhood dwellers. The association of homelessness and neighbourhood SES with total annual hospitalisation costs, length of stay, numbers of hospital and emergency department admissions and the probability of an operating room procedure, controlling for other covariates, was assessed using multivariate regression analysis. Our results suggest that the homeless and low-SES neighbourhood residents had a large proportion of total costs attributable to admissions for acute events related to the progression of disease. Hospitalisations for planned operating room procedures comprised a relatively larger proportion of hospitalisation costs for high-SES neighbourhood residents. One implication of our findings is that improvements in the continuity of care and cost savings on inpatient care may be realised through further development of social assistance programs aimed at reaching the homeless and residents of low-SES neighbourhoods.

Inpatient Health Services Utilization Among HIV-Infected Adult Patients in Care 2002–2007

“…Similarly, even after adjustment for other factors, Black race/ethnicity has repeatedly been associated with increased hospitalization rates 9–11,38. It has been hypothesized that patients with lower socioeconomic status have increased hospitalization rates39; in this study patients with public insurance were more likely to be hospitalized than those with private insurance. These sociodemographic differences were observed despite adjusting for CD4 count, the major indicator of HIV-related health status.…”

Emergency Department Utilization among a Cohort of HIV-positive Injecting Drug Users in a Canadian Setting

“…30 Delays in seeking treatment may result in more frequent and lengthy hospital admissions. 12, 23, 31 Further, previous studies have clearly demonstrated that unstable housing among IDU is associated with hazardous and unhygienic injecting practices that may also predispose individuals to infection. Unsafe injection practices associated with rushed injections in public places include the use of unclean water sources, decreased sanitization of the skin with alcohol prior to injecting, and the preparation of drugs directly in the barrel of the syringe by adding water and “shaking” without cooking or filtering.…”

Food Insecurity Is Associated with Greater Acute Care Utilization among HIV-Infected Homeless and Marginally Housed Individuals in San Francisco

“…Socioeconomic marginalization, in the form of unmet subsistence needs, may drive the acute care usage seen in these subpopulations. 13,14 Food insecurity, the limited availability of nutritionally adequate or safe food, or the inability to procure food in socially acceptable ways, 15 is an important form of socioeconomic marginalization. In the general population, food insecurity has been associated with many adverse health impacts, including poor nutritional status, [16][17][18][19][20][21] depression, [22][23][24][25][26] suicidal ideation, 26 obesity, 27 and increased cardiovascular risk.…”