Housing Status and Longitudinal Care Patterns After Injury - 18/07/25
, Jennifer Evans, MS b, Dave Graham Squire, PhD b, Sara Colom, PhD b, Kenneth Perez, MPH b, Maria Raven, MD, MPH, MS b, c, Rebecca Plevin, MD a, Hemal K. Kanzaria, MD, MSc b, c, Anne Stey, MD, MSc dAbstract |
Study objective |
Injury is a leading cause of hospitalization in people experiencing homelessness, yet post-injury care use is unknown. We sought to understand care use patterns in the 12 months after injury in people experiencing homelessness versus housed low-income Medicaid beneficiaries.
Methods |
We conducted a retrospective cohort study examining injured Medicaid beneficiaries in San Francisco from 2015 to 2022. Our primary exposure was housing status at the time of injury, obtained from linking the county’s only Level 1 Trauma Center’s Trauma Registry to the county-wide Coordinated Care Management System integrated data system. The primary outcome was emergency department (ED) visits in the 12 months after injury. Secondary outcomes were hospital admissions, outpatient visits, and mental health encounters. We adjusted for demographic, clinical, and injury variables as well as preinjury care use.
Results |
Among 5,998 people, 32.9% (N=1,926) were experiencing homelessness at injury. Approximately 76.9% were men, 82.3% spoke English, and 26.9% were Black. Thirty-four percent of people experiencing homelessness had 4 or more ED visits in the 12 months following injury. People experiencing homelessness had a 0.99 greater adjusted increase in ED visits after injury compared with before injury versus housed low-income Medicaid beneficiaries (95% confidence interval 0.64 to 1.33; P<.001). This pattern was observed for inpatient admissions, outpatient visits, and mental health encounters. ED visits and mental health encounters persisted above preinjury levels for 12 months following injury for people experiencing homelessness.
Conclusion |
The 12 months following injury had higher health-sector use among those experiencing homelessness than housed low-income Medicaid beneficiaries.
Le texte complet de cet article est disponible en PDF.Keywords : Trauma, Homelessness, Housing status, Health equity, Social determinants of health
Plan
| Please see page 159 for the Editor’s Capsule Summary of this article. |
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| Supervising editor: Richelle J. Cooper, MD, MSHS. Specific detailed information about possible conflicts of interest for individual editors is available at editors. |
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| Author contributions: HD, RP, MR, HK, and AS conceived and designed the study. JE, DGS, KP, and SC obtained, cleaned, and analyzed the data. DGS and JE additionally provided statistical oversight. KP additionally assisted with resource management and project organization. HD, RP, MR, HK, and AS interpreted the data. HD drafted the manuscript, and all authors contributed substantially to the revision. JE and HD had full access to all the data in the study and took responsibility for the integrity of the data and the accuracy of the data analysis. HD takes responsibility for the paper as a whole. |
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| Data sharing statement: Due to the sensitive nature of these data, including information on housing status, interactions with the criminal justice system, and encounters related to substance use, these data cannot be shared. |
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| All authors attest to meeting the four ICMJE.org authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. |
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| Funding and support: By Annals’ policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). Dr. Decker is a National Clinician Scholar with salary support from the VA. Dr. Stey’s time was funded by the National Institutes of Health/National Heart Lung, and Blood Institute (K23HL157832) and the Agency for Healthcare Research and Quality (R18HS029483). Dr. Kanzaria’s and Dr. Raven’s salaries are supported by a grant from the Benioff Homelessness and Housing Initiative, University of California, San Francisco, CA. Dr. Decker receives personal fees from Moon Surgical and Johnson and Johnson. Dr. Kanzaria works as an adviser from Amae Health. The rest of the authors have nothing to disclose. |
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| Presentation information: This work was presented at the American College of Surgeons Clinical Congress in San Francisco, CA, October 2024. |
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Vol 86 - N° 2
P. 158-168 - août 2025 Retour au numéro
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