Abstract 14708: Heart Failure While Homeless: Examining the Relationship Between HF Hospitalizations and Housing Insecurity

Abstract

Background: The association between housing insecurity and outcomes of hospitalizations for heart failure (HF) has not been previously well-established. Methods: We analyzed HF hospitalizations using the 2020 United States National Inpatient Sample database. Individuals were identified as having housing insecurity by related ICD-10 codes. Other demographic and comorbidity data were identified using corresponding ICD-10 codes. Characteristics of patients hospitalized for HF that were identified as having housing insecurity were compared to those hospitalized for HF who had no housing insecurity. We performed a multivariable risk adjustment for in-hospital mortality based on patient characteristics. Results: Out of 1,003,270 hospitalizations for HF, 16,150 were identified as having housing insecurity (1.6%). The average age of patients with housing insecurity hospitalized for HF was 56, as compared to 71 in the housed population. A higher proportion of patients in the housing-insecure group were Black (35% vs 20.1%) or Hispanic (11.1% vs 7.3%). Patients with housing insecurity were more likely to carry a diagnosis of alcohol use disorder (15.2% vs 3.3%) or substance use disorder (70.2% vs 17.8%), however they were less likely to use tobacco (18.3% vs 28.7%). Patients with housing insecurity were over 4.5 times more likely to have a primary Medicaid payer (52.4% vs 11.3%). Average length of stay did not differ between housing-insecure patients versus those without (5.37 vs 5.51 days). After adjusting for patient characteristics, housing insecurity was predictive of lower in-hospital mortality (OR 0.622, 95% CI 0.403 - 0.960). Conclusions: Significant differences occur between patients hospitalized for HF who also have housing insecurity. These differences are most pronounced for substance use and psychiatric disorders. However, housing insecurity was predictive of lower in-hospital mortality. Admissions for heart failure may provide important opportunities to screen for and address comorbid conditions for patients with housing insecurity, as well as for other vulnerable populations.