Smith Colin M, Feigal Jacob, Sloane Richard, Biederman Donna J
Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States.
Department of Medicine, Duke University School of Medicine, Durham, NC, United States.
Front Psychiatry. 2021 Dec 20;12:780366. doi: 10.3389/fpsyt.2021.780366. eCollection 2021.
People experiencing homelessness face significant medical and psychiatric illness, yet few studies have characterized the effects of multimorbidity within this population. This study aimed to (a) delineate unique groups of individuals based on medical, psychiatric, and substance use disorder profiles, and (b) compare clinical outcomes across groups. We extracted administrative data from a health system electronic health record for adults referred to the Durham Homeless Care Transitions program from July 2016 to June 2020. We used latent class analysis to estimate classes in this cohort based on clinically important medical, psychiatric and substance use disorder diagnoses and compared health care utilization, overdose, and mortality at 12 months after referral. We included 497 patients in the study and found 5 distinct groups: "low morbidity" (referent), "high comorbidity," "high tri-morbidity," "high alcohol use," and "high medical illness." All groups had greater number of admissions, longer mean duration of admissions, and more ED visits in the 12 months after referral compared to the "low morbidity" group. The "high medical illness" group had greater mortality 12 months after referral compared to the "low morbidity" group (OR, 2.53, 1.03-6.16; 95% CI, 1.03-6.16; = 0.04). The "high comorbidity" group (OR, 5.23; 95% CI, 1.57-17.39; < 0.007) and "high tri-morbidity" group (OR, 4.20; 95% CI, 1.26-14.01; < 0.02) had greater 12-month drug overdose risk after referral compared to the referent group. These data suggest that distinct groups of people experiencing homelessness are affected differently by comorbidities, thus health care programs for this population should address their risk factors accordingly.
无家可归者面临着严重的医疗和精神疾病，但很少有研究描述该人群中多种疾病并存的影响。本研究旨在：（a）根据医疗、精神和物质使用障碍概况划分独特的个体群体；（b）比较各群体的临床结局。我们从一个医疗系统的电子健康记录中提取了2016年7月至2020年6月转诊至达勒姆无家可归者护理过渡项目的成年人的管理数据。我们使用潜在类别分析，根据具有临床意义的医疗、精神和物质使用障碍诊断对该队列中的类别进行估计，并比较转诊后12个月的医疗保健利用率、药物过量情况和死亡率。我们纳入了497名患者进行研究，发现了5个不同的群体：“低发病率”（参照组）、“高共病率”、“高三重疾病率”、“高酒精使用率”和“高医疗疾病率”。与“低发病率”组相比，所有群体在转诊后的12个月内入院次数更多、平均住院时间更长、急诊就诊次数更多。与“低发病率”组相比，“高医疗疾病率”组在转诊后12个月的死亡率更高（比值比，2.53，1.03 - 6.16；95%置信区间，1.03 - 6.16；P = 0.04）。与参照组相比，“高共病率”组（比值比，5.23；95%置信区间，1.57 - 17.39；P < 0.007）和“高三重疾病率”组（比值比，4.20；95%置信区间，1.26 - 14.01；P < 0.02）在转诊后12个月的药物过量风险更高。这些数据表明，不同的无家可归人群受共病的影响不同，因此针对该人群的医疗保健项目应相应地解决他们的风险因素。
