When Health Insurance is Not a Factor: National Comparison of Homeless and Nonhomeless US Veterans Who Use Veterans Affairs Emergency Departments

Overview

Journal Am J Public Health

Specialty Public Health

Date 2013 Oct 24

PMID 24148061

Citations 30

Authors

Jack Tsai

Kelly M Doran

Robert A Rosenheck

Affiliations

Soon will be listed here.

Abstract

Objectives: We examined the proportion of homeless veterans among users of Veterans Affairs (VA) emergency departments (EDs) and compared sociodemographic and clinical characteristics of homeless and nonhomeless VA emergency department users nationally.

Methods: We used national VA administrative data from fiscal year 2010 for a cross-sectional study comparing homeless (n = 64,091) and nonhomeless (n = 866,621) ED users on sociodemographics, medical and psychiatric diagnoses, and other clinical characteristics.

Results: Homeless veterans had 4 times the odds of using EDs than nonhomeless veterans. Multivariate analyses found few differences between homeless and nonhomeless ED users on the medical conditions examined, but homeless ED users were more likely to have been diagnosed with a drug use disorder (odds ratio [OR] = 4.12; 95% confidence interval [CI] = 3.97, 4.27), alcohol use disorder (OR = 3.67; 95% CI = 3.55, 3.79), or schizophrenia (OR = 3.44; 95% CI = 3.25, 3.64) in the past year.

Conclusions: In a national integrated health care system with no specific requirements for health insurance, the major differences found between homeless and nonhomeless ED users were high rates of psychiatric and substance abuse diagnoses. EDs may be an important location for specialized homeless outreach (or "in" reach) services to address mental health and addictive disorders.

Citing Articles

Association of Homelessness and Unstable Housing With Cardiovascular Care Utilization Among Veterans.

Sokoloff L, Wu J, Eberly L, Nathan A, Julien H, Kobayashi T Circ Cardiovasc Qual Outcomes. 2024; 17(11):e010993.

PMID: 39492715 PMC: 11576242. DOI: 10.1161/CIRCOUTCOMES.124.010993.

Characteristics and Health Care Utilization of Patients With Housing Insecurity in the ED.

Ball M, Sack D, Druffner S, Jones I, Wrenn J, Sexton M JAMA Netw Open. 2024; 7(4):e248565.

PMID: 38669017 PMC: 11053378. DOI: 10.1001/jamanetworkopen.2024.8565.

Emergency Department Use Among Recently Homeless Adults in a Nationally Representative Sample.

Ryus C, Stefanovics E, Tsai J, Rhee T, Rosenheck R West J Emerg Med. 2023; 24(5):894-905.

PMID: 37788030 PMC: 10527843. DOI: 10.5811/westjem.59054.

The Association Between Homelessness and Key Liver-Related Outcomes in Veterans With Cirrhosis.

Pulaski M, Bittermann T, Taddei T, Kaplan D, Mahmud N Am J Gastroenterol. 2023; 119(2):297-305.

PMID: 37782293 PMC: 11823464. DOI: 10.14309/ajg.0000000000002535.

Developing an operational definition of housing instability and homelessness in Veterans Health Administration's medical records.

Tsai J, Szymkowiak D, Jutkowitz E PLoS One. 2022; 17(12):e0279973.

PMID: 36584201 PMC: 9803152. DOI: 10.1371/journal.pone.0279973.

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