Hospital readmission among people experiencing homelessness in England: a cohort study of 2772 matched homeless and housed inpatients.
access to hlth care
health inequalities
homelessness
record linkage
Journal
Journal of epidemiology and community health
ISSN: 1470-2738
Titre abrégé: J Epidemiol Community Health
Pays: England
ID NLM: 7909766
Informations de publication
Date de publication:
Jul 2021
Jul 2021
Historique:
received:
23
07
2020
revised:
06
11
2020
accepted:
04
12
2020
medline:
7
1
2021
pubmed:
7
1
2021
entrez:
6
1
2021
Statut:
ppublish
Résumé
Inpatients experiencing homelessness are often discharged to unstable accommodation or the street, which may increase the risk of readmission. We conducted a cohort study of 2772 homeless patients discharged after an emergency admission at 78 hospitals across England between November 2013 and November 2016. For each individual, we selected a housed patient who lived in a socioeconomically deprived area, matched on age, sex, hospital, and year of discharge. Counts of emergency readmissions, planned readmissions, and Accident and Emergency (A&E) visits post-discharge were derived from national hospital databases, with a median of 2.8 years of follow-up. We estimated the cumulative incidence of readmission over 12 months, and used negative binomial regression to estimate rate ratios. After adjusting for health measured at the index admission, homeless patients had 2.49 (95% CI 2.29 to 2.70) times the rate of emergency readmission, 0.60 (95% CI 0.53 to 0.68) times the rate of planned readmission and 2.57 (95% CI 2.41 to 2.73) times the rate of A&E visits compared with housed patients. The 12-month risk of emergency readmission was higher for homeless patients (61%, 95% CI 59% to 64%) than housed patients (33%, 95% CI 30% to 36%); and the risk of planned readmission was lower for homeless patients (17%, 95% CI 14% to 19%) than for housed patients (30%, 95% CI 28% to 32%). While the risk of emergency readmission varied with the reason for admission for housed patients, for example being higher for admissions due to cancers than for those due to accidents, the risk was high across all causes for homeless patients. Hospital patients experiencing homelessness have high rates of emergency readmission that are not explained by health. This highlights the need for discharge arrangements that address their health, housing and social care needs.
Sections du résumé
BACKGROUND
BACKGROUND
Inpatients experiencing homelessness are often discharged to unstable accommodation or the street, which may increase the risk of readmission.
METHODS
METHODS
We conducted a cohort study of 2772 homeless patients discharged after an emergency admission at 78 hospitals across England between November 2013 and November 2016. For each individual, we selected a housed patient who lived in a socioeconomically deprived area, matched on age, sex, hospital, and year of discharge. Counts of emergency readmissions, planned readmissions, and Accident and Emergency (A&E) visits post-discharge were derived from national hospital databases, with a median of 2.8 years of follow-up. We estimated the cumulative incidence of readmission over 12 months, and used negative binomial regression to estimate rate ratios.
RESULTS
RESULTS
After adjusting for health measured at the index admission, homeless patients had 2.49 (95% CI 2.29 to 2.70) times the rate of emergency readmission, 0.60 (95% CI 0.53 to 0.68) times the rate of planned readmission and 2.57 (95% CI 2.41 to 2.73) times the rate of A&E visits compared with housed patients. The 12-month risk of emergency readmission was higher for homeless patients (61%, 95% CI 59% to 64%) than housed patients (33%, 95% CI 30% to 36%); and the risk of planned readmission was lower for homeless patients (17%, 95% CI 14% to 19%) than for housed patients (30%, 95% CI 28% to 32%). While the risk of emergency readmission varied with the reason for admission for housed patients, for example being higher for admissions due to cancers than for those due to accidents, the risk was high across all causes for homeless patients.
CONCLUSIONS
CONCLUSIONS
Hospital patients experiencing homelessness have high rates of emergency readmission that are not explained by health. This highlights the need for discharge arrangements that address their health, housing and social care needs.
Identifiants
pubmed: 33402395
pii: jech-2020-215204
doi: 10.1136/jech-2020-215204
pmc: PMC8223662
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
681-688Subventions
Organisme : Medical Research Council
ID : MR/S003797/1
Pays : United Kingdom
Organisme : Medical Research Council
ID : MR/K006584/1
Pays : United Kingdom
Organisme : Department of Health
ID : DRF-2018-11-ST2-016
Pays : United Kingdom
Organisme : Wellcome Trust
Pays : United Kingdom
Organisme : Department of Health
ID : 13/156/10
Pays : United Kingdom
Informations de copyright
© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: NH is medical director, and AH is a trustee of the charity ‘Pathway: Healthcare for homeless people’. AS is clinical lead and manager for the ‘Find and Treat’ service at University College London Hospitals.