Homeless individuals in England are more likely to seek hospital services, especially emergency admissions compared with housed individuals, says a recent study published in BMJ Open.
England was estimated to have more than 300,000 homeless individuals in 2017, according to the homelessness charity, Shelter. Poor physical and mental health along with drug/alcohol misuse are highly prevalent in this population.
Researchers at The University of Manchester conducted a retrospective cohort study involving 16,161 homeless patients (age, 16-75 years) matched with 74,780 housed patients who attended an emergency department in England in 2013-2014. The Hospital Episode Statistics (HES) accident and emergency attendances data were used to identify the housed and homeless patients.
The mean hospital admission rates were for homeless and housed patients were 470 and 230 per 1000 patients per year, respectively. After adjusting for confounders, homeless patients had 1.79 times higher annual admissions than housed patients (incident rate ratio [IRR], 1.79; 95% CI, 1.69-1.90).
Furthermore, homeless patients had 2.08 times higher emergency admissions (IRR, 2.08; 95% CI, 1.95-2.21) and 1.65 times higher ambulatory care-sensitive (ACS) admissions (IRR, 1.65; 95% CI, 1.51-1.80) than housed patients. For ACS admissions, the effect was more pronounced for acute (IRR, 1.78; 95% CI, 1.64-1.93) than chronic (IRR, 1.45; 95% CI, 1.27-1.66) conditions.
Eleven per cent of additional emergency admissions in homeless patients were attributable to ACS admissions. Cellulitis and convulsions/epilepsy were the primary acute ACS conditions and angina was the primary chronic ACS condition driving emergency admissions in homeless patients.
The authors also highlight some limitations of the study. The "no fixed abode" label in HES may not be a precise indicator of homelessness. There is also a possibility of residual confounding when matching homeless patients to housed patients.
Lead author of the study, Charlie Moss stated in a press release: "Our analysis shows that some of the admissions may be potentially preventable with improved access to primary care, though these comprise a small share of the total. There is likely to be a complex array of factors which lead to the differences we observe."
Professor Matt Sutton from The University of Manchester added: "Addressing structural factors such as improved access to primary care could potentially reduce some of these admissions."
