APT Foundation, Inc., New Haven, CT, USA.
Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.
Subst Abus. 2023 Jan-Apr;44(1):62-72. doi: 10.1177/08897077231167291. Epub 2023 May 3.
Homelessness is an important social determinant of health (SDOH), impacting health outcomes for many medical conditions. Although homelessness is common among people with opioid use disorder (OUD), few studies systematically evaluate homelessness and other SDOH among people enrolled in standard of care treatment for OUD, medication for opioid use disorder (MOUD), or examine whether homelessness affects treatment engagement.
Using data from the 2016 to 2018 U.S. Treatment Episode Dataset Discharges (TEDS-D), patient demographic, social, and clinical characteristics were compared between episodes of outpatient MOUD where homelessness was reported at treatment enrollment versus independent housing using pairwise tests adjusted for multiple testing. A logistic regression model examined the relationship between homelessness and treatment length and treatment completion while accounting for covariates.
There were 188 238 eligible treatment episodes. Homelessness was reported in 17 158 episodes (8.7%). In pairwise analysis, episodes involving homelessness were significantly different from those involving independent living on most demographic, social, and clinical characteristics, with significantly greater social vulnerability in most SDOH variables ('s < .05). Homelessness was significantly and negatively associated with treatment completion (coefficient = -0.0853, < 0.001, 95% CI = [-0.114, -0.056], OR = 0.918) and remaining in treatment for greater than 180 days (coefficient = -0.3435, < 0.001, 95% CI = [-0.371, -0.316], OR = 0.709) after accounting for covariates.
Patients reporting homelessness at treatment entry in outpatient MOUD in the U.S. represent a clinically distinct and socially vulnerable population from those not reporting homelessness. Homelessness independently predicts poorer engagement in MOUD confirming that homelessness may be an independent predictor for MOUD treatment discontinuation nationally.
无家可归是健康的一个重要社会决定因素（SDOH），对许多医疗条件的健康结果都有影响。尽管无家可归在患有阿片类药物使用障碍（OUD）的人中很常见，但很少有研究系统地评估接受 OUD 标准护理治疗、阿片类药物使用障碍药物治疗（MOUD）或检查无家可归是否会影响治疗参与的人中的无家可归和其他 SDOH。
使用 2016 年至 2018 年美国治疗发作数据集出院（TEDS-D）的数据，使用配对检验比较报告治疗开始时无家可归的门诊 MOUD 发作与独立住房的患者人口统计学、社会和临床特征，并对多次检验进行调整。使用逻辑回归模型检查无家可归与治疗时间和治疗完成之间的关系，同时考虑协变量。
有 188238 个合格的治疗发作。17158 个发作（8.7%）报告无家可归。在成对分析中，涉及无家可归的发作在大多数人口统计学、社会和临床特征上与涉及独立生活的发作显著不同，大多数 SDOH 变量的社会脆弱性显著更大（<0.05）。无家可归与治疗完成显著负相关（系数= -0.0853，<0.001，95%CI= [-0.114，-0.056]，OR=0.918），并在考虑协变量后在治疗中停留超过 180 天的可能性降低（系数= -0.3435，<0.001，95%CI= [-0.371，-0.316]，OR=0.709）。
在美国门诊 MOUD 治疗开始时报告无家可归的患者代表了一个临床上独特且社会脆弱的人群，与不报告无家可归的患者不同。无家可归独立预测 MOUD 治疗参与度降低，证实无家可归可能是全国范围内 MOUD 治疗中断的一个独立预测因素。
