Feldman Brett J, Calogero Cristina G, Elsayed Kareem S, Abbasi Osman Z, Enyart Joshua, Friel Timothy J, Abunamous Yasir H, Dusza Stephen W, Greenberg Marna Rayl
Lehigh Valley Hospital and Health Network/USF MCOM CC & I-78, Department of Medicine, Allentown, Pennsylvania.
Lehigh Valley Hospital and Health Network/USF MCOM CC & I-78, Department of Emergency Medicine, Allentown, Pennsylvania.
West J Emerg Med. 2017 Apr;18(3):366-372. doi: 10.5811/westjem.2017.1.33054. Epub 2017 Mar 7.
According to the National Alliance to End Homelessness, the national rate of homelessness has been cited as 17.7 homeless people/10,000 people in the general population, and 24.8 homeless veterans/10,000 veterans in the general population. However, it is unknown what the prevalence of homelessness is in the emergency department (ED) setting. We set out to determine the prevalence of homelessness or at risk for homelessness in the ED setting.
Using a five-question screening tool derived from the U.S. Department of Housing and Urban Development, Health and Human Services and the Veterans Administration definition for homelessness, we surveyed all patients meeting inclusion/exclusion criteria on scheduled shifts in one of three EDs in Northeastern Pennsylvania. To participate, subjects had to be a registered patient in the ED, be 18 years or older, speak English, have the capacity to answer survey questions, not be critically ill, be willing to participate, and not have taken the survey before. We selected two survey periods to represent seasonal variations.
We included 4,395 subjects in the analysis. The mean age of those who screened positive for homelessness or at risk for homelessness was 43.1 (SD 16.6). Overall, 136 (3.1%) participants screened positive for at risk for homelessness and 309 (7.0%) screened positive for homelessness. A total of 103 subjects (9.8%) screened positive for homelessness or at risk for homelessness on weekends and 312 (10.3%) on weekdays (p=0.64). The proportion of those screening positive for homelessness or at risk for homelessness varied by site: 145 (7.5%) at the trauma center, 151(9.1%) at the suburban site, and 149 (18.7%) at the center city site, p<0.001.There was no statistical significance to the difference between the trauma center and the suburban site (p=.088), but there was statistical significance between both the suburban and the trauma center when compared to the center city site (both p<0.0001). The proportion of those screening positive for homelessness in the summer months (156, 7.5%) was similar to those in the winter months (153, 6.6%), p=0.23.
In our study, the overall prevalence of homelessness or at risk for homelessness was 10.1 percent. This prevalence did not seem to vary between weekdays and weekends. Additionally, summer months had a prevalence that was as concerning as winter months. The prevalence does, however, seem to vary by institutional characteristics even in the same geographic region. Understanding the patterns of prevalence of homelessness is a step toward considering possible interventions to assist this vulnerable population.
根据全国终止无家可归联盟的数据，全国无家可归率在普通人群中为每10000人中有17.7名无家可归者，在普通退伍军人中为每10000名退伍军人中有24.8名无家可归者。然而，在急诊科环境中无家可归的患病率尚不清楚。我们着手确定急诊科环境中无家可归或有无家可归风险的患病率。
我们使用了一种由美国住房和城市发展部、卫生与公众服务部以及退伍军人管理局的无家可归定义衍生而来的包含五个问题的筛查工具，对宾夕法尼亚州东北部三个急诊科之一的排班班次上所有符合纳入/排除标准的患者进行了调查。要参与调查，受试者必须是急诊科的注册患者，年龄在18岁及以上，会说英语，有能力回答调查问题，病情不危急，愿意参与，且之前未参加过该调查。我们选择了两个调查时期来代表季节变化。
我们在分析中纳入了4395名受试者。筛查出有无家可归风险或无家可归阳性的受试者的平均年龄为43.1岁（标准差16.6）。总体而言，136名（3.1%）参与者筛查出有无家可归风险阳性，309名（7.0%）筛查出无家可归阳性。共有103名受试者（9.8%）在周末筛查出有无家可归风险或无家可归阳性，312名（10.3%）在工作日筛查出阳性（p = 0.64）。筛查出有无家可归风险或无家可归阳性的比例因地点而异：创伤中心为145名（7.5%），郊区为151名（9.1%），市中心为149名（18.7%），p < 0.001。创伤中心和郊区之间的差异无统计学意义（p = 0.088），但与市中心相比，郊区和创伤中心两者均有统计学意义（两者p < 0.0001）。夏季筛查出无家可归阳性的比例（156名，7.5%）与冬季（153名，6.6%）相似，p = 0.23。
在我们的研究中，无家可归或有无家可归风险的总体患病率为10.1%。这一患病率在工作日和周末之间似乎没有差异。此外，夏季的患病率与冬季一样令人担忧。然而，即使在同一地理区域，患病率似乎也因机构特征而异。了解无家可归患病率模式是考虑可能的干预措施以帮助这一弱势群体的第一步。
