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We aimed to examine trends and characteristics of substance use (opioid, cocaine, marijuana, and heroin) among hospitalized homeless.
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Federal government websites often end in. The site is secure. Preview improvements coming to the PMC website in October Learn More or Try it out now. We aimed to examine trends and characteristics of substance use opioid, cocaine, marijuana, and heroin among hospitalized homeless patients in comparison with other hospitalized patients in 3 states. Use of opioid, cocaine, marijuana, heroin, respectively, was identified by the International Classification of Diseases, 9th Revision. Dependent variables were the use of substances opioid, cocaine, marijuana, and heroin , respectively. The main independent variable was homeless status. The subgroup analysis by age group was also conducted. Homeless patients were associated with more use of opioid RR \\\\\[CI\\\\\] , 1. All hospitalized patients including those who were homeless increased substance use except the use of cocaine RR \\\\\[CI\\\\\] , 0. Homeless status is associated with high risks of substance use among hospitalized patients. Homeless elderly are particularly vulnerable to use of hard drugs including cocaine and heroin during the opioid epidemics. In the United States U. Interagency Council on Homelessness reported an increase in the number of homeless individuals, especially, the numbers of children and families, during the past 3 decades. The association between socioeconomic status and health outcomes is well established. Furthermore, the high prevalence of substance use disorders in homeless populations is well recognized. The epidemic of opioid abuse and dependency over the past 2 decades has become a major health policy and public health concern in the U. Over 70, people died from drug overdose in There are myriad ways in homelessness poses risk of substance use. Unsheltered environments lead homeless individuals with mental illness to a high risk of substance abuse and dependence unless underlying mental health conditions are appropriately treated. According to the Boston cohort study of homeless individuals, they are 8 to 17 times more likely to experience drug overdose death, compared to the general population. According to a population-based survey for older homeless individuals, almost two thirds had dependency in at least 1 substance use. Therefore, this study, using large multi-state datasets, aimed to examine the trends in substance-related hospitalizations of homeless individuals compared to other hospitalized patients and demographic characteristics especially the age factor of substance use among hospitalized homeless patients. The state inpatient database SID , a publically available dataset, was used in this study. The SID includes an anonymous patient-level information including demographics, diagnostic codes and procedures. This study included all hospital records in which homeless information was recorded among the 3 sates of SID from the first quarter of to the third quarter of We excluded Arizona and Washington from to due to missing the homeless variable. After removing other missing values, the final number in our analysis was 32,, Substance use was defined as abuse, dependence, unspecified use, based on the International Classification of Diseases, 9 th edition, clinical modification codes in the Table S1, Supplemental Digital Content in accordance to the HCUP data notes and methods HCUP fast facts: opioid-related hospital use. Healthcare Cost and Utilization Project. October The independent variable was homeless status that was collected from the SID dataset. Homeless variable was constructed from data reported by hospitals, and this data does not distinguish whether they are chronically homeless or not and sheltered homeless or not. They included demographic and health related variables. Mental health conditions were defined as mood disorders, schizophrenia, other nonmood psychotic disorders, anxiety, stress-related, somatoform disorders, personality and factitious disorders in the Supplemental Digital Content 1. The number of comorbidities was comprised by the AHRQ comorbidity measures provided by AHRQ in SID, and it identifies coexisting medical conditions that are not directly related to the principal diagnosis. The characteristics and drug-related hospitalization rates between homeless individuals and other hospitalized patients were examined using t test. The general estimating equation Poisson model with log link \\\\\[ 21 \\\\\] was used to examine the effect of homeless status on substance-related hospitalizations by substance type after adjusting the covariates. To investigate time trends of drug-related hospitalizations, multi-level multivariate regressions were performed. Analysis was performed using the SAS software, version 9. Characteristics of homeless patients and other patients are listed in the Supplemental Digital Content 2. Among 32,, hospitalizations, homeless status was 0. Among the homeless individuals, most were males Mental health conditions accounted for Most of homeless hospitalizations were from state of Florida In opioid use, homeless individuals were more frequently hospitalized compared to all other hospitalized patients 6. The same pattern was observed in the use of cocaine The Supplemental Digital Contents 3 to 6 present the unadjusted annual rate of opioid, cocaine, marijuana, and heroin-related hospitalization per total , hospitalizations of homeless and general population. Substance use hospitalization rates monotonically increased every in all type of substance use. In opioid and marijuana-related hospitalization rate, the slope of the graph was steadily higher in homeless Figures S1 and S3, Supplemental Digital Content. Rate of the cocaine abuse admission decreased at first but increased slightly in the end in both homeless and general population Figure S2, Supplemental Digital Content. However, fluctuation was bigger in homeless. In heroin abuse admission rate, unstable graph was shown among homeless, but rate of the admission and slope was still higher in homeless individuals. We observed the same direction of association across substance type, higher risks of substance use hospitalizations among homeless status RRs and CIs were 1. In opioid and marijuana, a trend of monotonic increases was shown RRs and CIs were 2. In cocaine, a trend of steady decline was shown RRs and CIs, 0. In heroin, there was no consistent directionality of time trends. Male, age 20 to 39 years-old, mental health conditions, high number of comorbidities, and Washington state patients tended to be consistently associated with the use of all type substance except for cocaine use in Florida. White patients were more likely to use opioid and heroin. Minorities were more likely associated with the use of cocaine compared to White patients. Factors associated with use of substance by substance type in hospitalizations. We found important trends in odds of hospitalizations associated with uses of different substances. On average, opioid use-related hospitalizations increased twice from to in both homeless patients 2. In marijuana, homeless status 2. In heroin, the trend pattern was fluctuated in both general population and homeless status. Time trends of hospitalizations in use of substances by substance type and homeless status. In all age subgroups, homeless status was more likely associated with opioid, cocaine, and marijuana-related hospitalizations than the nonhomeless status. The use of cocaine and heroin among homeless patients were the most common among the age group 60 and older 6. Associations between homeless status and use of substances in hospitalizations by substance type and age group. To the best of our knowledge, this study is the first report examining trends and age-related characteristics of substance use opioid, cocaine, marijuana, and heroin hospitalizations among homeless individuals compared to all other patients. First, homeless population has a higher probability of substance use than the general population. Previous studies reported that unsheltered homeless individuals are prone to increase the likelihood of exposure to communicable diseases \\\\\[ 4 \\\\\] and to be sexually victimized, especially, women homeless individuals. The Affordable Care Act Medicaid expansion has led to the improvement of health care access and coverage for homeless individuals, especially for those with mental health and addiction conditions, main contributors to substance use. However, programs or policies for interstate homeless individuals and neighboring effects from out-of-state homeless individuals remain wilderness, \\\\\[ 35 \\\\\] which suggests that more cooperative interstate regional policy support targeting substance using homeless individuals is needed. These 2 groups have much higher risks of using substances compared to nonsubstance use patients in hospitals. It is well known that age affects the health behaviors of the homeless individuals. Previous studies have found that more than half of adolescent homeless persons experience substance abuse. Our study has limitations. First, we used the SID of 3 states where different in demography, health policies, and health services markets to reduce overrepresentation from neighboring exist. Controlling for state might not be able to fully reflect those differences in the analysis. Second, given the data limitation, we were unable to distinguish the purposes of opioid and marijuana use as recreational, medical, or illicit. Third, the SID dataset might have nature of under-reporting of homeless individuals. For example, the annual average number of homeless individuals in state of Washington in SID was only There was wide variation in estimating homeless individuals in state of Washington between from federal agency \\\\\[ 1 \\\\\] and , from state agency. Fourth, we could not specify the types of homeless status; first, transient, chronic, interstate, or former. This limitation may hinder our findings to offer more specific information to assist allocation of limited resources to public health investment and policy interventions. In conclusion, homeless status poses higher risks of substance use hospitalized patients than that of other hospitalized patients across all substance types, opioid, cocaine, marijuana, and heroin. The continuous trends of increase in substance use in all type of substances except cocaine are observed regardless of homeless status among hospitalized patients. Old homeless patients are more vulnerable to hard drugs including cocaine and heroin, compared to their younger counterparts. Kim, Jay J. Kim, Seong Park, Jay J. Trends and age-related characteristics of substance use in the hospitalized homeless population. The authors have no funding and conflicts of interest to disclose. Supplemental digital content is available for this article. As a library, NLM provides access to scientific literature. Medicine Baltimore. Published online Feb Pearl C. Find articles by Seong Park. Jay J. Find articles by Jay J. Published by Wolters Kluwer Health, Inc. This is an open access article distributed under the Creative Commons Attribution License 4. Supplemental Digital Content. Abstract We aimed to examine trends and characteristics of substance use opioid, cocaine, marijuana, and heroin among hospitalized homeless patients in comparison with other hospitalized patients in 3 states. Keywords: homeless, hospitalisation, substance use. Introduction In the United States U. Methods 2. Data source and study population The state inpatient database SID , a publically available dataset, was used in this study. Independent variable The independent variable was homeless status that was collected from the SID dataset. Covariates They included demographic and health related variables. Statistical analysis The characteristics and drug-related hospitalization rates between homeless individuals and other hospitalized patients were examined using t test. Results Characteristics of homeless patients and other patients are listed in the Supplemental Digital Content 2. Table 1 Patient characteristics of use of substances by substance type. Open in a separate window. Table 2 Factors associated with use of substance by substance type in hospitalizations. Table 3 Time trends of hospitalizations in use of substances by substance type and homeless status. Table 4 Associations between homeless status and use of substances in hospitalizations by substance type and age group. Discussion To the best of our knowledge, this study is the first report examining trends and age-related characteristics of substance use opioid, cocaine, marijuana, and heroin hospitalizations among homeless individuals compared to all other patients. Data curation: Hyeki Park, Jay J. Project administration: Jay J. Supervision: Jay J. S-yC and JWY contributed equally. Improving health care for homeless people. JAMA ; —7. Morbidity and mortality in homeless individuals, prisoners, sex workers, and individuals with substance use disorders in high-income countries: a systematic review and meta-analysis. Lancet ; — Homelessness and health. 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Public Health Rep ; : Suppl 1 : S Hepatitis C screening in opioid epidemics in the United States and societal perspectives. Liver Int ; 38 — Meta-regression of hepatitis C virus infection in relation to time since onset of illicit drug injection: the influence of time and place. The meaning of default options for potential organ donors. A prospective study of substance use and housing stability in a homeless population. Soc Psychiatry Psychiatr Epidemiol ; 45 — Homelessness and substance abuse: which comes first? Aust Soc Work ; 61 — Hospitalization costs associated with homelessness in New York City. N Engl J Med ; — Efforts to control prescription drug abuse: why clinicians should be concerned and take action as essential advocates for rational policy. CA Cancer J Clin ; 64 — Perceived unmet need and barriers to care amongst street-involved people who use illicit drugs. Drug Alcohol Rev ; 36 — Drug-induced deaths — United States, — MMWR ; 60 —1. Statistical Brief March Hoptel equalizes length of stay for homeless and domiciled inpatients. Med Care ; 38 — The health of the homeless. Sociol Compass ; 12 :e Elderly homeless: a comparison of older and younger adult emergency shelter seekers in Bakersfield, California. Am Behav Sci ; 45 — Risks associated with long-term homelessness among women: battery, rape, and HIV infection. Int J Health Serv ; 25 — Substance abuse disorders among homeless and runaway adolescents. J Drug Issues ; 35 — Longitudinal predictors of homelessness: findings from the National Longitudinal Survey of Youth J Youth Stud ; 18 — Running away from home: a longitudinal study of adolescent risk factors and young adult outcomes. J Youth Adolesc ; 40 — Articles from Medicine are provided here courtesy of Wolters Kluwer Health. Copy Download.
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