Khan Safi U, Yedlapati Siva H, Khan Muhammad Zia, Virani Salim S, Blaha Michael J, Sharma Garima, Jordan John E, Kash Bita A, Vahidy Farhaan S, Arshad Adeel, Mossialos Elias, Nasir Khurram
Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston TX.
Department of Medicine, Erie County Medical Center, Buffalo, NY.
Curr Probl Cardiol. 2023 Aug;48(8):101190. doi: 10.1016/j.cpcardiol.2022.101190. Epub 2022 Mar 26.
Homelessness is a major social determinant of health. We studied the clinical and economic profile of homeless young adults hospitalized with stroke. We studied the National Inpatient Sample database (2002-2017) to evaluate trends of stroke hospitalization, clinical outcomes, and health expenditure in homeless vs non-homeless young adults (<45 years). We identified 3134 homeless individuals out of 648,944 young adults. Homeless patients were more likely to be men, Black adults and had a higher prevalence of cardiometabolic risk factors and psychiatric disorders than non-homeless adults. Both homeless and non-homeless adults had a similar prevalence of ischemic and hemorrhagic stroke. Between 2002 and 2017, hospitalization rates per million increased for both non-homeless (295.8-416.8) and homeless adults (0.5-3.6) (P ≤ 0.01). Between 2003 and 2017, the decline in in-hospital mortality was limited to non-homeless adults (11%-9%), while it has increased in homeless adults (3%-11%) (P < 0.01). The prevalence of acute myocardial infarction (6.8% vs 3.3%, P < 0.01), and acute kidney injury (13.1% vs 9.4%, P < 0.01) was also higher in homeless vs. non-homeless adults. The length of stay and inflation-adjusted care cost were comparable between both study groups. Finally, a higher proportion of homeless patients left the hospital against medical advice than non-homeless adults. Homeless young stroke patients had significant comorbidities, increased hospitalization rates, and adverse clinical outcomes. Therefore, public health interventions should focus on multidisciplinary care to reduce health care disparities among young homeless adults.
无家可归是健康的一个主要社会决定因素。我们研究了因中风住院的无家可归青年成年人的临床和经济状况。我们研究了国家住院样本数据库（2002 - 2017年），以评估无家可归与非无家可归青年成年人（<45岁）中风住院的趋势、临床结果和医疗支出。在648,944名青年成年人中，我们确定了3134名无家可归者。与非无家可归成年人相比，无家可归患者更可能是男性、黑人成年人，并且心血管代谢危险因素和精神障碍的患病率更高。无家可归和非无家可归成年人的缺血性和出血性中风患病率相似。2002年至2017年期间，非无家可归成年人（从295.8增至416.8）和无家可归成年人（从0.5增至3.6）每百万人的住院率均有所上升（P≤0.01）。2003年至2017年期间，住院死亡率的下降仅限于非无家可归成年人（从11%降至9%），而无家可归成年人的住院死亡率有所上升（从3%升至11%）（P<0.01）。无家可归成年人急性心肌梗死的患病率（6.8%对3.3%，P<0.01）和急性肾损伤的患病率（13.1%对9.4%，P<0.01）也高于非无家可归成年人。两个研究组之间的住院时间和经通胀调整的护理费用相当。最后，违背医嘱出院 的无家可归患者比例高于非无家可归成年人。无家可归的年轻中风患者有明显的合并症、更高的住院率和不良临床结果。因此，公共卫生干预措施应侧重于多学科护理，以减少年轻无家可归成年人之间的医疗保健差距。
