Abstract
Background The population-level demand for critical care services among the homeless (H) remains unknown, with only sparse data on the characteristics and outcomes of those managed in the ICU. Methods The Texas Inpatient Public Use Data File and annual federal reports were used to identify H hospitalizations and annual estimates of the H population between 2007 and 2014. The incidence of ICU admissions in the H population, the characteristics of ICU-managed H, and factors associated with their short-term mortality were examined. Results Among 52,206 H hospitalizations 15,553 (29.8%) were admitted to ICU. The incidence of ICU admission among state H population rose between 2007 and 2014 from 28.0 to 96.6/1,000 (p < 0.0001), respectively. Adults aged ≥ 45 years and minorities accounted for 70.2% and 57.6%, respectively, of the growth in volume of ICU admissions. Short-term mortality was 3.2%, with odds of death increased with age, comorbidity burden, and number of failing organs. Conclusions The demand for critical care services was increasingly high among the H and was contrasted by low short-term mortality among ICU admissions. These findings, coupled with the persistent health disparities among minority H, underscore the need to effectively address homelessness and reduce barriers to longitudinal appropriate prehospital care among the H.
Highlights
Homelessness remains an intractable problem in highincome countries [1]
Challenges remain in accurately tracking homeless populations [1, 2], annual estimates show progressive decrease in the homeless population in the United States (US) [2]
Because state-specific data on age and race/ethnicity are not provided in reports on the homeless population in the US [2] and in order to further explore the evolving demand for critical care services among the homeless in context of the growing Texas population and changing state demographics, we examined the incidence of ICU admission of homeless patients with the general state population as denominator
Summary
Homelessness remains an intractable problem in highincome countries [1]. challenges remain in accurately tracking homeless populations [1, 2], annual estimates show progressive decrease in the homeless population in the United States (US) [2]. The prevalent comorbidities and homelessness itself are combined with possibly inadequate control of chronic illness and lack of timely interventions for otherwise manageable acute illness, related to barriers in accessing medical care [4, 5] These factors likely underlie the high utilization of inpatient healthcare resources by the homeless, with high hospitalization and readmission rates and with higher inpatient costs, substantially exceeding those among their nonhomeless counterparts [6, 7]. The demand for critical care services was increasingly high among the H and was contrasted by low short-term mortality among ICU admissions These findings, coupled with the persistent health disparities among minority H, underscore the need to effectively address homelessness and reduce barriers to longitudinal appropriate prehospital care among the H
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