Critical illness among patients experiencing homelessness: a retrospective cohort study

PurposeTo understand the epidemiology and healthcare use of critically ill patients experiencing homelessness compared to critically ill patients with stable housing.MethodsThis retrospective population-based cohort study included adults admitted to any ICU in Alberta, Canada, for a 3-year period. Administrative and clinical data from the hospital, ICU and emergency department were used to examine healthcare resource use (processes of care, ICU and hospital length of stay, hospital readmission and emergency room visits). Regression was used to quantify differences in healthcare use by housing status.Results2.3% (n = 1086) of patients admitted to the ICU were experiencing homelessness; these patients were younger, more commonly admitted for medical reasons and had fewer comorbidities compared to those with stable housing. Processes of care in the ICU were mostly similar, but healthcare use after ICU was different; patients experiencing homelessness who survived their index hospitalization were more than twice as likely to have a visit to the emergency department (OR = 2.3 times, 95% CI 2.0-2.6, < 0.001) or be readmitted to hospital (OR = 2.1, 95% CI 1.8-2.4, p < 0.001) within 30 days, and stayed 10.1 days longer in hospital (95% CI 8.6-11.6, p < 0.001), compared with those who have stable housing.ConclusionsPatients experiencing homelessness have different characteristics at ICU admission and have similar processes of care in ICU, but their subsequent use of healthcare resources was higher than patients with stable housing. These findings can inform strategies to prepare patients experiencing homelessness for discharge from the ICU to reduce healthcare resource use after critical illness.

Automated summary

This study aimed to compare the epidemiology and healthcare use of critically ill patients experiencing homelessness to those with stable housing. The results showed that homelessness was associated with younger age, more admissions for medical reasons, and fewer comorbidities. While the processes of care in the ICU were similar, patients experiencing homelessness had higher healthcare resource use after ICU, including more visits to the emergency department, hospital readmissions, and longer hospital stays. These findings highlight the need for strategies to reduce healthcare resource use among critically ill patients experiencing homelessness.