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Mental Health and Substance Abuse Drive Hospitalizations Among Homeless

MedicalResearch.com Interview with:

Dr. Rishi Wadhera, MD  Cardiology Fellow Brigham and Women's Hospital Harvard Medical School.

Dr. Wadhera

Dr. Rishi Wadhera, MD 
Cardiology Fellow
Brigham and Women’s Hospital
Harvard Medical School.

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: In the United States, an estimated half a million people are homeless on any given night. In recent years, policy efforts to improve the health of homeless individuals have intensified, but there is little large-scale, contemporary data on how these efforts have impacted patterns of acute illness in this vulnerable population.

In this study, we examined trends, causes, and outcomes of hospitalizations among homeless individuals in three states – Massachusetts, Florida, and California – from 2007 to 2013. We found that hospitalization rates among homeless adults increased over this period of time.

Strikingly, over one-half of these hospitalizations were for mental illness and substance use disorder. More broadly, homeless adults were hospitalized for a very different set of reasons compared with demographically similar non-homeless adults. In addition, homeless individuals had longer lengths of hospitalization but lower total costs per hospitalization.

MedicalResearch.com: What should readers take away from your report?

Response: Despite greater policy and public health focus over the last few decades, mental illness and substance use disorder still remain the primary drivers of hospitalization among homeless adults, similar to patterns observed in analyses of US cities from the 1990s. Ongoing policy efforts should address barriers to the use of ambulatory care services, and behavioral health services in particular, to help improve the long-term health of homeless individuals. 

MedicalResearch.com: What recommendations do you have for future research as a result of this work? 

Response: We need to better understand why hospitalization rates are rising among homeless adults in these three states, and whether these patterns reflect what is happening on a national scale. As policy initiatives under the Affordable Care Act continue to evolve, such as higher funding for community health centers and expansion of Medicaid eligibility, future studies should seek to understand their impact on the health of this highly vulnerable population.


Trends, Causes, and Outcomes of Hospitalizations for Homeless Individuals: A Retrospective Cohort Study
Wadhera, Rishi K.; Choi, Eunhee; Shen, Changyu; More
Medical Care. ., Post Author Corrections: November 19, 2018

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Last Updated on December 5, 2018 by Marie Benz MD FAAD