Abstract 11705: Comparing Healthcare Utilization and Health Outcomes of Infective Endocarditis Between People Experiencing Homelessness and People With Secure Housing

Abstract

Introduction: Infective endocarditis (IE) is uniformly fatal if left untreated. Lower socioeconomic status has been shown to increase risk for community-acquired bacteremia, leading to possible IE. People experiencing homelessness (PEH) face risk factors for IE, such as inadequate access to personal hygiene, lack of consistent resting places to prevent skin breakdown, substance use, and inadequately treated comorbidities. This study seeks to compare characteristics of health utilization and outcomes for PEH hospitalized for IE with people with secure housing (PSH). Hypothesis: Mortality rate and healthcare utilization due to IE are higher for PEH compared to PSH. Methods: We used New York Statewide Inpatient Database between 2009 and 2014 to identify patients over 18 years of age admitted with the diagnosis of IE. With homelessness as the exposure variable, outcomes included 1] hospitalization cost per day, 2] length of stay (LOS), and 3] in-hospital mortality. Multivariate regression models, adjusted by patient characteristics, were used to explore the associations between homelessness and outcomes. Results: We identified 809,491 IE hospitalizations (25,968 homeless and 783,523 non-homeless). PEH were significantly more likely to be white (16.9% in PEH and 62.6% in PSH, p< .001). Homelessness was significantly associated with lower odds of in-hospital mortality (adjusted Odds Ratio [aOR] 0.88, p < .001), lower means ratio of cost (Means Ratio 0.99, p < .001), longer LOS (Incidence Rate Ratio=1.03, p < .001), and increased risk for readmission within 30 days of hospital discharge (aOR 1.1, p<.01). Conclusions: The lower risk of hospital mortality for IE amongst PEH is unexpected given the higher burden of comorbidities and risk factors in this vulnerable group. It is possible that a significant proportion of PEH are dying outside hospital walls due to barriers in connecting with medical care. Lower hospitalization cost per day along with longer LOS could also reflect the time intensive but lower cost services required for complex discharge planning efforts for PEH. These results quantify and highlight the need for further study to understand overall mortality in PEH along with effective discharge planning strategies that address these disparities.