Nav: Home

Study shows rising rates of hospitalization in the homeless

November 30, 2018

November 30, 2019 - Hospitalization rates among homeless adults have increased sharply in recent years, with a very different set of causes from those in non-homeless individuals, reports a study in the January issue of Medical Care. The journal is published in the Lippincott portfolio by Wolters Kluwer.

"Despite greater policy and public health focus over the last few decades, mental illness and substance use disorder still remain the primary drivers of acute hospitalizations among homeless adults," according to the new research, led by by Rishi Wadhera, MD, MPhil, of the Smith Center for Outcomes Research at Beth Israel Deaconess Medical and Brigham and Women's Hospital, Boston. The authors discuss the implications for policies to improve healthcare and outcomes for homeless Americans.

Data from Three States Show 'Urgent Need' to Improve Care for Homeless Adults

The researchers assessed trends in hospital admissions for homeless adults from 2007 to 2013 in three states:  Massachusetts, Florida, and California. The analysis included data on more than 185,000 hospitalizations for homeless individuals and 32 million admissions for non-homeless individuals. The two groups were standardized for demographic characteristics: average age was 46 years, 76 percent were male, and 62 percent were white.

All three states showed a significant increase in hospitalizations for homeless adults: from 294 to 420 per 1,000 homeless residents in Massachusetts, from 161 to 240 per 1,000 in Florida, and from 133 to 164 per 1,000 in California. Most homeless patients were uninsured (42 percent) or insured by Medicaid (32 percent).

Fifty-two percent of homeless patients were hospitalized for mental illness or substance use disorder, compared to 18 percent for non-homeless individuals. Other reasons for hospitalization were less likely in homeless individuals, including cardiovascular disease, gastrointestinal illness, and injury or poisoning.

Homeless individuals spent more days in the hospital - possibly because discharge decisions were affected by their lack of stable housing. They also had lower average costs of care, which may reflect differences in the intensity of care. In-hospital mortality was lower among homeless adults: 0.9 versus 1.2 percent.

"In the United States, an estimated 553,000 people are homeless on any given night," according to the authors. Recent years have seen intensified efforts to address the health of the homeless population, including Medicaid expansion and increased funding for healthcare centers and clinical services under the Affordable Care Act (ACA). Few studies have looked at how these policy initiatives have affected patterns of hospitalization among homeless people.

"We found that hospitalizations among homeless persons are rising," said Dr. Wadhera. "We think this is related to aging of the homeless population, and potentially, the rise of the opioid epidemic. Strikingly, more than half of hospitalizations for homeless adults were for mental health and substance use disorders, which we suspect reflects limited access to and coordination of behavioral health services." Expanded mental health and substance use disorder services under the ACA, as well as newer integrated healthcare delivery approaches, might help to improve provision of behavioral health services to homeless patients, the authors suggest.

"There is really is an urgent need to reduce financial and nonfinancial barriers to the use of ambulatory care, for behavioral health services in particular, to improve long-term management of physical and mental illness for homeless individuals," said senior author Karen Joynt Maddox, MD, MPH, of Washington University in St. Louis. "We need better longitudinal data and further studies to understand how Medicaid expansion and other policy initiatives affect the health of this highly vulnerable population."
-end-
Click here to read "Trends, Causes, and Outcomes of Hospitalizations for Homeless Individuals"

DOI: 10.1097/MLR.0000000000001015

About Medical Care

Rated as one of the top ten journals in health care administration, Medical Care is devoted to all aspects of the administration and delivery of health care. This scholarly journal publishes original, peer-reviewed papers documenting the most current developments in the rapidly changing field of health care. Medical Care provides timely reports on the findings of original investigations into issues related to the research, planning, organization, financing, provision, and evaluation of health services. In addition, numerous special supplementary issues that focus on specialized topics are produced with each volume. Medical Care is the official journal of the Medical Care Section of the American Public Health Association

About Wolters Kluwer

Wolters Kluwer is a global leader in professional information, software solutions, and services for the health, tax & accounting, finance, risk & compliance, and legal sectors. We help our customers make critical decisions every day by providing expert solutions that combine deep domain knowledge with specialized technology and services.

Wolters Kluwer, headquartered in the Netherlands, reported 2017 annual revenues of €4.4 billion. The company serves customers in over 180 countries, maintains operations in over 40 countries, and employs approximately 19,000 people worldwide.

Wolters Kluwer Health is a leading global provider of trusted clinical technology and evidence-based solutions that engage clinicians, patients, researchers and students with advanced clinical decision support, learning and research and clinical intelligence. For more information about our solutions, visit http://healthclarity.wolterskluwer.com and follow us on LinkedIn and Twitter @WKHealth.

Wolters Kluwer Health

Related Mental Health Articles:

Food insecurity can affect your mental health
Food insecurity (FI) affects nearly 795 million people worldwide. Although a complex phenomenon encompassing food availability, affordability, utilization, and even the social norms that define acceptable ways to acquire food, FI can affect people's health beyond its impact on nutrition.
Climate change's toll on mental health
When people think about climate change, they probably think first about its effects on the environment, and possibly on their physical health.
Quantifying nature's mental health benefits
The BioScience Talks podcast features discussions of topical issues related to the biological sciences.
Sexism may be harmful to men's mental health
Men who see themselves as playboys or as having power over women are more likely to have psychological problems than men who conform less to traditionally masculine norms, according to research published by the American Psychological Association.
Mental health matters
UCSB researchers study the effectiveness of an innovative program designed to help youth learn about mental health.
Could mental math boost emotional health?
Engaging the brain's dorsolateral prefrontal cortex (DL-PFC) while doing mental math may be connected with better emotional health, according to Duke researchers.
Program will train mental health providers, improve health care in rural Missouri
A new graduate education program at the University of Missouri has received nearly $700,000 from the Health Resources and Services Administration in the US Department of Health and Human Services to train psychology doctoral candidates in integrated, primary health care settings, in an effort to improve health care for underserved populations with mental health and physical disorders.
Loss of employer-based health insurance in early retirement affects mental, physical health
The loss of private health insurance from an employer can lead to poorer mental and physical health as older adults transition to early retirement, according to a study by Georgia State University.
Ocean views linked to better mental health
Here's another reason to start saving for that beach house: new research suggests that residents with a view of the water are less stressed.
New study shows electronic health records often capture incomplete mental health data
This study compares information available in a typical electronic health record (EHR) with data from insurance claims, focusing on diagnoses, visits, and hospital care for depression and bipolar disorder.

Related Mental Health Reading:

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Digital Manipulation
Technology has reshaped our lives in amazing ways. But at what cost? This hour, TED speakers reveal how what we see, read, believe — even how we vote — can be manipulated by the technology we use. Guests include journalist Carole Cadwalladr, consumer advocate Finn Myrstad, writer and marketing professor Scott Galloway, behavioral designer Nir Eyal, and computer graphics researcher Doug Roble.
Now Playing: Science for the People

#529 Do You Really Want to Find Out Who's Your Daddy?
At least some of you by now have probably spit into a tube and mailed it off to find out who your closest relatives are, where you might be from, and what terrible diseases might await you. But what exactly did you find out? And what did you give away? In this live panel at Awesome Con we bring in science writer Tina Saey to talk about all her DNA testing, and bioethicist Debra Mathews, to determine whether Tina should have done it at all. Related links: What FamilyTreeDNA sharing genetic data with police means for you Crime solvers embraced...