Trends in hospital coding for people experiencing homelessness in Canada, 2015-2020: a descriptive study

In 2018, hospitals were mandated to record homelessness using International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Canada (ICD-10-CA code Z59.0). We sought to answer whether the coding mandate affected the volume of patients identified as experiencing homelessness in acute inpatient hospitalizations and if there was any geographic variation.

We conducted a serial cross-sectional study describing 6 fiscal years (2015/16 to 2020/21) of hospital administrative data from the Hospital Morbidity Database. We reported frequencies and percentages of hospitalizations with a Z59.0 diagnostic code and disaggregated by several types of Canadian geographies. Controlling for fiscal quarter (coded Q1 to Q4) and province or territory, adjusted logistic regression models quantified the odds of Z59.0 being coded during hospital stays.

The frequency and percentage of people experiencing homelessness in hospitalization records across Canada increased from 6934 (0.12%) in 2015/16 to 21 529 (0.41%) in 2020/21. Trends varied by province and territory. Recording of the Z59.0 code increased following the mandate (adjusted odds ratio 2.29, 95% confidence interval 2.25-2.32), relative to the pre-mandate period.

The 2018 coding mandate coincided with an increase in the use of the Z59.0 code to document homelessness in health care administrative data; however, trends varied by jurisdiction. The ICD-10-CA code Z59.0 presents a promising opportunity for standardized and routinely collected data to identify people experiencing homelessness in hospital administrative data.