无家可归者住院的趋势、原因和结果：一项回顾性队列研究。
Trends, Causes, and Outcomes of Hospitalizations for Homeless Individuals: A Retrospective Cohort Study.
机构信息
Richard and Susan Smith Center for Outcomes Research, Division of Cardiology, Beth Israel Deaconess Medical and Harvard Medical School.
Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA.
出版信息
Med Care. 2019 Jan;57(1):21-27. doi: 10.1097/MLR.0000000000001015.
OBJECTIVES
In the United States, an estimated 553,000 people are homeless on any given night. Few data provide large-scale, contemporary insight with regard to recent patterns of acute illness in this vulnerable population. We evaluated patterns, causes, and outcomes of acute hospitalization among homeless persons compared with a demographics-standardized and risk-standardized nonhomeless cohort.
METHODS
Retrospective study comparing 185,292 hospitalizations for homeless individuals and 32,322,569 hospitalizations for demographics-standardized nonhomeless individuals between 2007 and 2013 in Massachusetts, Florida, and California. Annual hospitalization rates for homeless persons were calculated and causes of hospitalization were compared with a demographics-standardized nonhomeless cohort. Logistic and linear regression models were used to estimate risk-standardized outcomes.
RESULTS
From 2007 to 2013, hospitalizations for the homeless increased in Massachusetts (294 to 420 hospitalizations per 1000 homeless residents), Florida (161 to 240/1000), and California (133 to 164/1000). Homeless patients were on average 46 years of age, often male (76.1%), white (62%), and either uninsured (41.9%) or insured by Medicaid (31.7%). Hospitalizations for homeless persons, compared with demographics-standardized nonhomeless, were more frequently for mental illness and substance use disorder (52% vs. 18%, P<0.001). Homeless compared with risk-standardized nonhomeless individuals had lower in-hospital mortality rates (0.9% vs. 1.2%, P<0.001), longer mean length of stay (6.5 vs. 5.9 d, P<0.001), and lower mean costs per day ($1 535 vs. $1 834, P<0.001).
CONCLUSIONS
Hospitalizations among homeless persons are rising. Despite greater policy and public health focus over the last few decades, mental illness and substance use remain primary drivers of acute hospitalization among homeless adults. Policy efforts should address barriers to the use of ambulatory care services, and behavioral health services in particular, to help reduce acute care use and improve the long-term health of homeless individuals.
目的
在美国，每晚约有 55.3 万人无家可归。很少有数据能大规模、当代地了解这一弱势群体最近的急性疾病模式。我们评估了与人口统计学标准化和风险标准化非无家可归队列相比，无家可归者急性住院的模式、原因和结果。
方法
回顾性研究比较了 2007 年至 2013 年马萨诸塞州、佛罗里达州和加利福尼亚州 185292 例无家可归者住院治疗和 32322569 例人口统计学标准化非无家可归者住院治疗的数据。计算了无家可归者的年住院率，并将住院原因与人口统计学标准化非无家可归队列进行了比较。使用逻辑和线性回归模型来估计风险标准化的结果。
结果
从 2007 年到 2013 年，马萨诸塞州（每 1000 名无家可归居民中有 420 例住院治疗，而 294 例）、佛罗里达州（每 1000 名中有 240 例住院治疗，而 161 例）和加利福尼亚州（每 1000 名中有 164 例住院治疗，而 133 例）无家可归者的住院率增加。无家可归的患者平均年龄为 46 岁，通常为男性（76.1%）、白人（62%），要么没有保险（41.9%），要么由医疗补助保险（31.7%）承保。与人口统计学标准化的非无家可归者相比，无家可归者的住院治疗更频繁地用于治疗精神疾病和物质使用障碍（52%比 18%，P<0.001）。与风险标准化的非无家可归者相比，无家可归者的院内死亡率较低（0.9%比 1.2%，P<0.001），平均住院时间较长（6.5 天比 5.9 天，P<0.001），平均每日费用较低（每天 1535 美元比每天 1834 美元，P<0.001）。
结论
无家可归者的住院率正在上升。尽管在过去几十年中政策和公共卫生方面的关注度有所提高，但精神疾病和物质使用仍是无家可归成年人急性住院的主要原因。政策努力应解决使用门诊服务的障碍，特别是行为健康服务，以帮助减少急性护理的使用并改善无家可归者的长期健康状况。
Zotero 插件