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. 2020 Sep;35(9):2576-2583.
doi: 10.1007/s11606-020-05946-4. Epub 2020 Jun 17.

Association of Homelessness with Hospital Readmissions-an Analysis of Three Large States

Sameed Ahmed M Khatana  1   2   3 , Rishi K Wadhera  4   5   6 , Eunhee Choi  4   5   6 , Peter W Groeneveld  7   8   9   10 , Dennis P Culhane  11 , Margot Kushel  12 , Dhruv S Kazi  4   5   6 , Robert W Yeh  4   5   6 , Changyu Shen  4   5   6
Affiliations

Association of Homelessness with Hospital Readmissions-an Analysis of Three Large States

Sameed Ahmed M Khatana et al. J Gen Intern Med. 2020 Sep.

Abstract

Background: Individuals experiencing homelessness have higher hospitalization and mortality rates compared with the housed. Whether they also experience higher readmission rates, and if readmissions vary by region or cause of hospitalization is unknown.

Objective: Evaluate the association of homelessness with readmission rates across multiple US states.

Design: Retrospective analysis of administrative claims PATIENTS: All inpatient hospitalizations in Florida, Massachusetts, and New York from January 2010 to October 2015 MAIN MEASURES: Thirty- and 90-day readmission rates KEY RESULTS: Out of a total of 23,103,125 index hospitalizations, 515,737 were for patients who were identified as homeless at the time of discharge. After adjusting for cause of index hospitalization, state, demographics, and clinical comorbidities, 30-day and 90-day readmission rates were higher for index hospitalizations in the homeless compared with those in the housed group. The difference in 30-day readmission rates between homeless and housed groups was the largest in Florida (30.4% vs. 19.3%; p < 0.001), followed by Massachusetts (23.5% vs. 15.2%; p < 0.001) and New York (15.7% vs. 13.4%; p < 0.001) (combined 17.3% vs. 14.0%; p < 0.001). Among the most common causes of hospitalization, 30-day readmission rates were 4.1 percentage points higher for the homeless group for mental illness, 4.9 percentage points higher for diseases of the circulatory system, and 2.4 percentage points higher for diseases of the digestive system.

Conclusions: After adjusting for demographic and clinical characteristics, homelessness is associated with significantly higher 30- and 90-day readmission rates, with a significant variation across the three states. Interventions to reduce the burden of readmissions among individuals experiencing homelessness are urgently needed. Differences across states point to the potential of certain public policies to impact health outcomes for individuals experiencing homelessness.

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Conflict of interest statement

The authors declare that they do not have a conflict of interest.

Figures

Figure 1
Figure 1
Adjusted for age, demographics, gender, race/ethnicity, state, cause of index hospitalization by clinical classification of diseases (CCS) category, and presence of 22 clinical comorbidities. Error bars omitted due to small standard errors
Figure 2
Figure 2
adjusted for age, demographics, gender, race/ethnicity, state, cause of index hospitalization by clinical classification of diseases (CCS) category, and presence of 22 clinical comorbidities. Error bars omitted due to small standard errors
See this image and copyright information in PMC

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