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Emergency department utilisation by homeless children in Dublin, Ireland: a retrospective review
Niamh O' Brien1, Nuala Quinn2, Birgitta Joyce2
1Paediatric Emergency Medicine, Children's Health Ireland at Temple Street, Dublin, Ireland niamhobrien36@gmail.com.
Insights
Homeless children in Dublin, Ireland, were younger, less vaccinated, and more reliant on emergency services for healthcare. This study highlights disparities in healthcare access for vulnerable populations, including infants and minority ethnic groups.
Area of Science:
- Public Health
- Paediatric Medicine
- Sociology
Background:
- European family homelessness is a growing concern but remains under-researched.
- Understanding the healthcare needs of homeless children is crucial for targeted interventions.
Purpose of the Study:
- To compare the demographics, healthcare utilization, clinical presentation, and outcomes of homeless children versus non-homeless children attending a paediatric emergency department.
- To identify specific vulnerable groups within the homeless paediatric population.
Main Methods:
- A retrospective review of 3,138 homeless children attending a Dublin paediatric emergency department (2017-2020).
- Comparison with a random cohort of 1,500 non-homeless paediatric attendances (2019).
- Homelessness defined using the European Typology of Homelessness and Housing Exclusion.
Main Results:
- Homeless children were less likely to be ethnically Irish or born in Ireland, with over-representation of Irish Travellers, Roma, and black ethnicities.
- Homeless children were younger, less vaccinated, had fewer registered general practitioners, and were more likely to use ambulance services.
- Homeless children presented with lower acuity and had fewer hospital admissions compared to non-homeless children.
Conclusions:
- Infants, Irish Travellers, Roma, and black ethnicities were over-represented in homeless paediatric presentations.
- Homeless children demonstrated an increased reliance on emergency services for primary healthcare needs, indicating potential gaps in accessible primary care.
Introduction:
Despite increasing prevalence, European family homelessness remains under-researched.
Methods:
A retrospective review was performed of homeless children attending a paediatric emergency department in Dublin, Ireland, from 1 January 2017 to 31 December 2020. Comparison was made with a random cohort of 1500 non-homeless paediatric attendances in 2019. Homelessness was defined using the European Typology of Homelessness and Housing Exclusion, including those with addresses of no fixed abode, government homeless accommodation and certain residential settings. The objectives were to compare presentations between homeless and non-homeless children. We were interested in determining differences regarding demographics, healthcare utilisation, clinical presentation and outcomes.
Results:
Of 197 437 attendances 3138 (1.59%) were homeless. Compared with the non homeless, homeless children were less likely to be ethnically Irish (37.4% vs 74.6%, p<0.001) or have been born in Ireland (82.3% vs 96.2%, p<0.001). Irish Travellers (3% vs 0.8%), Roma (22.5% vs 2.4%) and black (21.1% vs 4.2%) ethnicities were over-represented (p<0.001) in the homeless cohort.Homeless children were younger (age <12 months: 26% vs 16%; p<0.001), less likely to be fully vaccinated (73.6% vs 81.9%, p<0.001) and have registered general practitioners (89.7% vs 95.8%, p<0.001). They were more likely to represent within 2 weeks (15.9% vs 10.5%, p<0.001), and use ambulance transportation (13.2% vs 6.7%, p<0.001). Homeless children had lower acuity presentations (triage category 4-5: 47.2% vs 40.7%, p<0.001) and fewer admissions (5.9% vs 8.4%, p<0.001) than non-homeless children.
Discussion:
Infants, Irish Travellers, Roma and black ethnicities were over-represented in homeless presentations. Homeless children had increased reliance on emergency services for primary healthcare needs.
