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标题：Predictors of Medical or Surgical and Psychiatric Hospitalizations Among a Population-Based Cohort of Homeless Adults
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作者：Catharine Chambers ; Marko Katic ; Shirley Chiu 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2013
卷号：103
期号：Suppl 2
页码：S380-S388
DOI：10.2105/AJPH.2013.301646
语种：English
出版社：American Public Health Association
摘要：Objectives. We identified factors associated with inpatient hospitalizations among a population-based cohort of homeless adults in Toronto, Ontario. Methods. We recruited participants from shelters and meal programs. We then linked them to administrative databases to capture hospital admissions during the study (2005–2009). We used logistic regression to identify predictors of medical or surgical and psychiatric hospitalizations. Results. Among 1165 homeless adults, 20% had a medical or surgical hospitalization, and 12% had a psychiatric hospitalization during the study. These individuals had a total of 921 hospitalizations, of which 548 were medical or surgical and 373 were psychiatric. Independent predictors of medical or surgical hospitalization included birth in Canada, having a primary care provider, higher perceived external health locus of control, and lower health status. Independent predictors of psychiatric hospitalization included being a current smoker, having a recent mental health problem, and having a lower perceived internal health locus of control. Being accompanied by a partner or dependent children was protective for hospitalization. Conclusions. Health care need was a strong predictor of medical or surgical and psychiatric hospitalizations. Some hospitalizations among homeless adults were potentially avoidable, whereas others represented an unavoidable use of health services. Homeless adults are frequent users of inpatient hospital services. In a nationally representative sample of homeless persons in the United States, almost 1 in 4 respondents reported being hospitalized in the past year, a rate 4 times higher than US norms. 1 The frequent use of inpatient hospital services partially reflects the high prevalence of acute and chronic disease, injuries and assaults, substance use, and mental illness among this population. 1–3 However, the high rates of hospitalization have also been attributed to a lack of access to primary and preventative care, particularly in the United States, where 50% of homeless people have no health insurance. 1,4–7 In a nationally representative sample of persons who used homeless services in the United States, Kushel et al. 1 showed that lack of health insurance and African American race/ethnicity, compared with non-Latino White race/ethnicity, were the only factors significantly associated with a lower odds of self-reported hospitalization. In a subsequent study, Kushel et al. 4 showed that being uninsured significantly decreased the likelihood of self-reporting a nonmaternal hospitalization in the past year, whereas food instability and housing instability significantly increased the odds. Similarly, Lim et al. 5 in their population-based study of homeless women in Los Angeles, California, showed that having health insurance was significantly associated with an increased likelihood of hospitalization. These studies pointed to the enabling influence of health insurance on access to inpatient hospital services in the United States; however, these findings were likely not applicable in a Canadian setting in which individuals have access to universal health insurance coverage. Furthermore, most previous studies of health care utilization in the United States relied on self-reported data 1,8–10 or restricted their analysis to a single health care institution. 11,12 The purpose of this study was to identify factors associated with inpatient hospitalizations among a population-based cohort of homeless adults in Toronto, Ontario, using comprehensive administrative data. Analyses were stratified by type of inpatient service to examine the influence of predictors separately for medical or surgical and psychiatric hospitalizations.