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Factors Associated With Hospital Readmission Among Patients Experiencing Homelessness

Keshab Subedi1, Binod Acharya2, Shweta Ghimire3

  • 1Institute for Research on Equity and Community Health, ChristianaCare Health Systems, Wilmington, Delaware.

American Journal of Preventive Medicine
|April 3, 2022
PubMed

Insights

Patients experiencing homelessness have significantly higher hospital readmission rates, more than double those of non-homeless individuals. Specific health conditions and Black racial identity were linked to increased acute care use in this vulnerable population.

Area of Science:

  • Health Services Research
  • Public Health
  • Health Disparities

Background:

  • Homelessness is linked to elevated acute care use and adverse health outcomes.
  • Understanding healthcare utilization patterns in homeless populations is crucial for targeted interventions.

Purpose of the Study:

  • To compare hospital readmission rates between homeless and non-homeless patients.
  • To identify clinical and demographic factors influencing acute care utilization among homeless individuals.

Main Methods:

  • Retrospective analysis of patient data from 2018-2019.
  • 1:1 propensity score matching comparing homeless (n=1,329) and non-homeless (n=143,360) cohorts.
  • Time-to-event analysis for readmission rates, including 30-day readmissions.

Main Results:

  • Homeless patients had a 42.8% 30-day readmission rate versus 19.9% for non-homeless patients.
  • The hazard of 30-day readmission was 2.6 times higher for homeless individuals.
  • Comorbidities (e.g., substance use disorder, depression, CKD, obesity, arthritis, HIV/AIDS, epilepsy) and Black racial identity were associated with shorter time to readmission.

Conclusions:

  • Homeless patients exhibit higher acute care utilization.
  • Addressing social determinants of health, destigmatization, and comprehensive comorbidity management is vital for improving health outcomes for people experiencing homelessness.
Abstract

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