Long-term outcomes in trauma patients experiencing houselessness or housing insecurity

Patients experiencing houselessness/housing insecurity have increased morbidity and mortality compared with stably housed (nonhouselessness/housing insecurity) populations, but their long-term outcomes after traumatic injury are understudied. We sought to describe these outcomes and evaluate their association with houselessness/housing insecurity, after accounting for measured confounding factors.

Retrospective cohort study of adult patients admitted to an urban, level 1 trauma center, July 1, 2015-May 31, 2023, with an Injury Severity Score ≥9 who completed a validated patient-reported outcome measures survey 6-12 months postinjury. Houselessness/housing insecurity was determined based on chart review documenting houselessness/housing insecurity 1 year before or after injury. Outcomes included new functional limitations, 12-Item Short Form Health Survey scores, and post-traumatic stress disorder, anxiety, and depression screens. Multivariable regression was used to determine the association between houselessness/housing insecurity and the outcomes of interest.

One thousand two hundred sixteen patients were included, of which 193 (15.8%) experienced houselessness/housing insecurity. These patients were more often young (median age, 48 years [34-59] vs 54 years [31-73]), Black (52% vs 29%), government insured (68% vs 47%), reported a previous psychiatric illness (31% vs 18%) or alcohol/substance use (64% vs 30%), and had a penetrating mechanism of injury (24% vs 9%). In adjusted analysis, houselessness/housing insecurity was associated with new functional limitations (odds ratio, 2.23; 95% confidence interval, 1.53-3.26; P < .001), lower 12-Item Short Form Health Survey physical and mental health scores (βˆ = -3.30; standard error, 1.19; P < .01 and βˆ = -7.61; standard error, 1.33; P < .001), and positive screens for depression (odds ratio, 3.98; 95% confidence interval, 2.57-6.17; P < .001) and anxiety (odds ratio, 3.23; 95% confidence interval, 2.10-4.98; P < .001).

Patients experiencing houselessness/housing insecurity have worse long-term functional and mental health outcomes compared with housed patients even after adjusting for relevant confounders. Targeted interventions during recovery, including assistance with housing procurement, may be considered as a strategy to mitigate these outcomes.