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Ryus C, Stefanovics E, Tsai J, Rhee TG, Rosenheck RA. Emergency Department Use Among Recently Homeless Adults in a Nationally Representative Sample. West J Emerg Med 2023; 24:894-905. [PMID: 37788030 PMCID: PMC10527843 DOI: 10.5811/westjem.59054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 05/11/2023] [Accepted: 05/24/2023] [Indexed: 10/04/2023] Open
Abstract
Introduction: In this study we examined the association of homelessness and emergency department (ED) use, considering social, medical, and mental health factors associated with both homelessness and ED use. We hypothesized that social disadvantage alone could account for most of the association between ED use and homelessness. Methods: We used nationally representative data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC-III). Emergency department use within the prior year was categorized into no use (27,674; 76.61%); moderate use (1-4 visits: 7,972; 22.1%); and high use (5 or more visits: 475; 1.32%). We used bivariate analyses followed by multivariable-adjusted logistic regression analyses to identify demographic, social, medical, and mental health characteristics associated with ED use. Results: Among 36,121 respondents, unadjusted logistic regression showed prior-year homelessness was strongly associated with moderate and high prior-year ED use (odds ratio [OR] 2.31 and 7.34, respectively, P < 0.001). After adjusting for sociodemographic factors, the associations of homelessness with moderate/high ED use diminished (adjusted OR [AOR] 1.27 and 1.62, respectively, both P < 0.05). Adjusting for medical/mental health variables, alone, similarly diminished the association between homelessness and moderate/high ED use (AOR 1.26, P < .05 and 2.07, P < 0.001, respectively). In a final stepwise model including social and health variables, homelessness was no longer significantly associated with moderate or high ED use in the prior year. Conclusion: After adjustment for social disadvantage and health problems, we found no statistically significant association between homelessness and ED use. The implications of our findings suggest that ED service delivery must address both health issues and social factors.
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Affiliation(s)
- Caitlin Ryus
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Elina Stefanovics
- U.S. Department of Veterans Affairs New England Mental Illness Research, Education, and Clinical Center, West Haven, Connecticut
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Jack Tsai
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
- VA National Center on Homelessness among Veterans, Washington, DC
- School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas
| | - Taeho Greg Rhee
- U.S. Department of Veterans Affairs New England Mental Illness Research, Education, and Clinical Center, West Haven, Connecticut
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
- Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, Connecticut
| | - Robert A. Rosenheck
- U.S. Department of Veterans Affairs New England Mental Illness Research, Education, and Clinical Center, West Haven, Connecticut
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
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Patil SJ. Task Sharing Chronic Disease Self-Management Training With Lay Health Coaches to Reduce Health Disparities. Ann Fam Med 2020; 18:2-3. [PMID: 31937525 PMCID: PMC7227464 DOI: 10.1370/afm.2513] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 12/03/2019] [Indexed: 01/22/2023] Open
Affiliation(s)
- Sonal J Patil
- Department of Family and Community Medicine, University of Missouri, Columbia, Missouri
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