TY - JOUR
T1 - Hospital readmission among people experiencing homelessness in England: a cohort study of 2772 matched homeless and housed inpatients
AU - Lewer, Dan
AU - Menezes, Dee
AU - Cornes, Michelle
AU - Blackburn, Ruth M.
AU - Byng, Richard
AU - Clark, Michael
AU - Denaxas, Spiros
AU - Evans, Hannah
AU - Fuller, James
AU - Hewett, Nigel
AU - Kilmister, Alan
AU - Luchenski, Serena April
AU - Manthorpe, Jill
AU - McKee, Martin
AU - Neale, Joanne
AU - Story, Alistair
AU - Tinelli, Michela
AU - Whiteford, Martin
AU - Wurie, Fatima
AU - Yavlinsky, Alexei
AU - Hayward, Andrew
AU - Aldridge, Robert
PY - 2021/7
Y1 - 2021/7
N2 - BackgroundInpatients experiencing homelessness are often discharged to unstable accommodation or the street, which may increase the risk of readmission.MethodsWe conducted a cohort study of 2772 homeless patients discharged after an emergency admission at 78 hospitals across England between November 2013 and November 2016. For each individual, we selected a housed patient who lived in a socioeconomically deprived area, matched on age, sex, hospital, and year of discharge. Counts of emergency readmissions, planned readmissions, and Accident and Emergency (A&E) visits post-discharge were derived from national hospital databases, with a median of 2.8 years of follow-up. We estimated the cumulative incidence of readmission over 12 months, and used negative binomial regression to estimate rate ratios.ResultsAfter adjusting for health measured at the index admission, homeless patients had 2.49 (95% CI 2.29 to 2.70) times the rate of emergency readmission, 0.60 (95% CI 0.53 to 0.68) times the rate of planned readmission and 2.57 (95% CI 2.41 to 2.73) times the rate of A&E visits compared with housed patients. The 12-month risk of emergency readmission was higher for homeless patients (61%, 95% CI 59% to 64%) than housed patients (33%, 95% CI 30% to 36%); and the risk of planned readmission was lower for homeless patients (17%, 95% CI 14% to 19%) than for housed patients (30%, 95% CI 28% to 32%). While the risk of emergency readmission varied with the reason for admission for housed patients, for example being higher for admissions due to cancers than for those due to accidents, the risk was high across all causes for homeless patients.ConclusionsHospital patients experiencing homelessness have high rates of emergency readmission that are not explained by health. This highlights the need for discharge arrangements that address their health, housing and social care needs.
AB - BackgroundInpatients experiencing homelessness are often discharged to unstable accommodation or the street, which may increase the risk of readmission.MethodsWe conducted a cohort study of 2772 homeless patients discharged after an emergency admission at 78 hospitals across England between November 2013 and November 2016. For each individual, we selected a housed patient who lived in a socioeconomically deprived area, matched on age, sex, hospital, and year of discharge. Counts of emergency readmissions, planned readmissions, and Accident and Emergency (A&E) visits post-discharge were derived from national hospital databases, with a median of 2.8 years of follow-up. We estimated the cumulative incidence of readmission over 12 months, and used negative binomial regression to estimate rate ratios.ResultsAfter adjusting for health measured at the index admission, homeless patients had 2.49 (95% CI 2.29 to 2.70) times the rate of emergency readmission, 0.60 (95% CI 0.53 to 0.68) times the rate of planned readmission and 2.57 (95% CI 2.41 to 2.73) times the rate of A&E visits compared with housed patients. The 12-month risk of emergency readmission was higher for homeless patients (61%, 95% CI 59% to 64%) than housed patients (33%, 95% CI 30% to 36%); and the risk of planned readmission was lower for homeless patients (17%, 95% CI 14% to 19%) than for housed patients (30%, 95% CI 28% to 32%). While the risk of emergency readmission varied with the reason for admission for housed patients, for example being higher for admissions due to cancers than for those due to accidents, the risk was high across all causes for homeless patients.ConclusionsHospital patients experiencing homelessness have high rates of emergency readmission that are not explained by health. This highlights the need for discharge arrangements that address their health, housing and social care needs.
UR - https://pearl.plymouth.ac.uk/context/pms-research/article/1930/viewcontent/Hospital_20readmission_20among_20people_20experiencing_20homelessness_20in_20England_20a_20cohort_20study_20of_202772_20matched_20homeless_20and_20housed_20in.pdf
U2 - 10.1136/jech-2020-215204
DO - 10.1136/jech-2020-215204
M3 - Article
SN - 0143-005X
VL - 75
SP - 681
EP - 688
JO - Journal of Epidemiology and Community Health
JF - Journal of Epidemiology and Community Health
IS - 7
ER -
