Hospital readmission among people experiencing homelessness in England: a cohort study of 2772 matched homeless and housed inpatients

Dan Lewer; Dee Menezes; Michelle Cornes; Ruth M Blackburn; Richard Byng; Michael Clark; Spiros Denaxas; Hannah Evans; James Fuller; Nigel Hewett; Alan Kilmister; Serena April Luchenski; Jill Manthorpe; Martin McKee; Joanne Neale; Alistair Story; Michela Tinelli; Martin Whiteford; Fatima Wurie; Alexei Yavlinsky; Andrew Hayward; Robert Aldridge

doi:10.1136/jech-2020-215204

Hospital readmission among people experiencing homelessness in England: a cohort study of 2772 matched homeless and housed inpatients

J Epidemiol Community Health. 2021 Jul;75(7):681-688. doi: 10.1136/jech-2020-215204. Epub 2021 Jan 5.

Authors

Dan Lewer^{1

2

3}, Dee Menezes⁴, Michelle Cornes⁵, Ruth M Blackburn⁴, Richard Byng⁶, Michael Clark⁷, Spiros Denaxas^{4

8}, Hannah Evans⁴, James Fuller⁵, Nigel Hewett⁹, Alan Kilmister⁵, Serena April Luchenski⁴, Jill Manthorpe⁵, Martin McKee¹⁰, Joanne Neale¹¹, Alistair Story¹², Michela Tinelli⁷, Martin Whiteford¹³, Fatima Wurie³, Alexei Yavlinsky⁴, Andrew Hayward^{2

3}, Robert Aldridge⁴

Affiliations

¹ Institute of Health Informatics, University College London, London, UK d.lewer@ucl.ac.uk.
² Collaborative Centre for Inclusion Health, University College London, London, UK.
³ Institute of Epidemiology and Health Care, University College London, London, UK.
⁴ Institute of Health Informatics, University College London, London, UK.
⁵ NIHR Policy Research Unit in Health and Social Care Workforce, King's College London, London, UK.
⁶ Community and Primary Care Research Group, University of Plymouth, Plymouth, UK.
⁷ Care Policy and Evaluation Centre, The London School of Economics and Political Science, London, UK.
⁸ Alan Turing Institute, British Library, London, UK.
⁹ Pathway Charity, London, UK.
¹⁰ Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK.
¹¹ National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
¹² Find & Treat, University College London Hospitals NHS Foundation Trust, London, UK.
¹³ Department of Nursing & Community Health, Glasgow Caledonian University, Glasgow, UK.

Abstract

Background: Inpatients experiencing homelessness are often discharged to unstable accommodation or the street, which may increase the risk of readmission.

Methods: We 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.

Results: After 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.

Conclusions: Hospital 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.

Keywords: access to hlth care; health inequalities; homelessness; record linkage.

Abstract

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