Comparison of clinical characteristics and outcomes between homeless and non-homeless patients admitted to intensive care units: An observational propensity-matched cohort study in Korea

Unhoused and Injured: Injury Characteristics and Outcomes in Unhoused Trauma Patients

INTRODUCTION

The unhoused population is known to be at high risk for traumatic injury. However, there are scarce data regarding injury patterns and outcomes for this patient group. This study aims to investigate any differences in injury characteristics and hospital outcomes between unhoused and housed patients presenting with traumatic injuries.

METHODS

We conducted a 3-y retrospective cohort study at a level 1 trauma center in a metropolitan area with a large unhoused population. All adult trauma patients who were identified as unhoused or housed underinsured (HUI) were included in the study. Injury characteristics, comorbidities, and hospital outcomes were compared between the two groups.

RESULTS

A total of 8450 patients were identified, of which 7.5% were unhoused. Compared to HUI patients, unhoused patients were more likely to sustain minor injuries (65.2% versus 59.1%, P = 0.003) and more likely to be injured by assault (17.9% versus 12.4%, P < 0.001), stab wound (17.7% versus 10.8%, P < 0.001), and automobile versus pedestrian or bike (21.0% versus 15.8% P < 0.001). We found that unhoused patients had higher odds of mortality (adjusted odds ratio [AOR]: 1.93, 95% confidence interval [CI]: 1.10-3.36, P = 0.021), brain death (AOR: 5.40, 95% CI: 2.11-13.83, P < 0.001), bacteremia/sepsis (AOR: 4.36, 95% CI: 1.20-15.81, P = 0.025), and increased hospital length of stay (regression coefficient: 0.08, 95% CI: 0.03-0.12, P = 0.003).

CONCLUSIONS

This study observed significant disparities in injury characteristics and hospital outcomes between the unhoused and HUI groups. Our results suggest that these disparities are impacted by social determinants of health unique to the unhoused population.

Interpersonal relationships and drug use over time among homeless people: a qualitative study

Background

Homelessness is one of the most severe forms of social exclusion and is an important public health issue. It is characterized by processes of weakening of interpersonal bonds. The objective of this study was, therefore, to elucidate how interpersonal relationships change over the life cycle of homeless drug and alcohol users.

Method

We used a qualitative methodology. The participants were adults who had a history of homelessness and use of alcohol and other drugs. The interviews were semi structured and used a timeline instrument. All interview were audio recorded, transcribed, and submitted to thematic analysis.

Results

Twenty individuals participated in the study. Reports on social exclusion over time stood out in respect of four main themes and their respective subthemes: Theme 1 – Childhood: instability upbringing, abuse, violence, and an absent or not very present father figure; Theme 2 – Adolescence: school dropout and failure; acceptance of gender and sexual orientation; birth of first child, living with a partner or getting married: Theme 3 – Adulthood: estrangement or conflicting relationship with family; health problems; drug trafficking and prostitution; Theme 4 – Cross-cutting factors: death of relatives and substance use.

Conclusion

The results suggest that interpersonal relationships are permeated by successive breakups, conflicts and other events that start in childhood and can have a cumulative effect in later stages of life, and cross the subsequent phases. Substance abuse and dependence are mentioned as cross-cutting factors that intensify social exclusion in all stages of life.

Supplementary Information

Supplementary information accompanies this paper at 10.1186/s12889-020-09880-2.

Pattern of infections in French and migrant homeless hospitalised at Marseille infectious disease units, France: A retrospective study, 2017-2018

BACKGROUND

No research has been conducted on the clinical characteristics and outcomes of homeless patients (HP) hospitalized in Infectious Disease Units (IDU).

METHODS

We conducted a retrospective survey among 98 HP and 98 non-HP admitted between 2017 and 2018 in several IDUs in Marseille, France.

RESULTS

HP were more likely to be migrant, to report frequent alcohol consumption or illicit drug use, and to present with respiratory symptoms at admission compared to controls. The most common final diagnoses in HP were respiratory tract infections (other than pulmonary tuberculosis [PTB], 35.7%), sexually transmitted infections (20.4%), cutaneous and mucosal infections (19.4%) and tuberculosis (12.2%). Sexually transmitted infections and ectoparasite infestations were significantly more frequent in HP compared to controls. One HP died from pleural effusion as a complication of PTB. The surviving HP had a longer length of stay (LOS, average 11.6 ± 13.6 days, p < 0.0001) than controls; independent factors of increased LOS were tobacco use (p = 0.009), tuberculosis infection (p < 0.0001), urinary tract infection (p = 0.018) and bacteraemia (p = 0.018). After hospital discharge, attendance at subsequent planned consultations was significantly lower in HP (0.72 ± 1.25 times/persons) compared to controls (2.03 ± 2.2).

CONCLUSIONS

We suggest that HP present specific demographic characteristics and patterns of infectious diseases compared to other patients and therefore require adapted management.