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Housing Status and Longitudinal Care Patterns After Injury
Hannah Decker1, Jennifer Evans2, Dave Graham Squire2
1Department of Surgery, University of California, San Francisco, San Francisco, CA.
Annals of Emergency Medicine
|May 7, 2025
Summary
People experiencing homelessness had significantly higher healthcare use, including emergency department visits and mental health encounters, in the 12 months after injury compared to housed individuals. This highlights critical post-injury care disparities for vulnerable populations.
Area of Science:
- Health Services Research
- Trauma Care
- Health Disparities
Background:
- Injury is a major cause of hospitalization among individuals experiencing homelessness.
- Post-injury healthcare utilization patterns for this population remain understudied.
Purpose of the Study:
- To compare healthcare use in the 12 months following injury between people experiencing homelessness and housed, low-income Medicaid beneficiaries.
- To identify patterns in emergency department visits, hospital admissions, outpatient visits, and mental health encounters.
Main Methods:
- Retrospective cohort study of injured Medicaid beneficiaries in San Francisco (2015-2022).
- Housing status at injury linked via Trauma Registry and Coordinated Care Management System.
- Adjusted for demographic, clinical, injury, and pre-injury care variables.
Main Results:
- 32.9% of 5,998 injured individuals were experiencing homelessness.
- People experiencing homelessness showed a greater adjusted increase in emergency department visits post-injury compared to housed individuals (P<.001).
- This increased utilization extended to inpatient admissions, outpatient visits, and mental health encounters, persisting above pre-injury levels for 12 months.
Conclusions:
- The 12 months following injury are associated with higher healthcare sector utilization for individuals experiencing homelessness compared to their housed counterparts.
- Significant disparities in post-injury care access and utilization exist for vulnerable populations.
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