Online Program

Epidemiology of violent injury in emergency rooms among people experiencing homelessness in san francisco

Monday, November 4, 2013

Sarah Dobbins, MPH, Department of Surgery, University of California San Francisco, san francisco, CA
Randi Smith, MD, MPH, Department of Surgery, University of California, San Francisco, San Francisco, CA
Caitlin Robinson, University of California Berkeley, san francisco, CA
Abigail Evans, University of California San Francisco, san francisco, CA
Rochelle Dicker, MD, FACS, San Francisco Injury Center & Department of Surgery, University of California, San Francisco, San Francisco
Background: San Francisco has a large homeless population; in this 46-square mile city, 5,728 were estimated to be homeless in 2011. Many more people are transiently housed in single room occupancy hotels, intermittently without shelter. People experiencing homelessness are high users of emergency department services, and also have high rates of violent injury. To date, no study has described housing status and outcomes associated with interpersonal violence among this population. We hypothesized that housing status is an independent risk factor for injury recidivism. Methods: A cohort of adult patients admitted to the Emergency Department at our Trauma Center in 2010 – 2011 after violent injury was evaluated. Housing status and demographic data was obtained using admission information. Three categories were used for comparison: Housed, Transitionally-Housed, and Homeless. Outcomes assessed included injury characteristics and injury recidivism. Sixty-three percent of transiently-housed patients were injured by stabbings, 18% by gun violence; fifty-one percent of homeless patients were injured by stabbings, 32% by gun violence. Compared to those with stable housing, transiently-housed patients were 3.2 times more likely to be a violent injury recidivist, compared to homeless patients, who were 3.8 times as likely (p<.001). Homeless individuals are more likely to be a recidivist compared to those with transient housing (p<.01). Conclusions: High rates of violence and injury recidivism exist among the homeless in San Francisco. Our study demonstrates this population is extremely vulnerable to interpersonal violence. Improving access to housing, substance abuse treatment and mental health services should be emphasized in prevention efforts.

Learning Areas:

Public health or related research

Learning Objectives:
Describe violent injuries that occur in homeless people admitted to the Emergency Room, compare injury characteristics and rates of injury recidivism based on housing status.

Keyword(s): Violence

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have an MPH in Epidemiology, and have been working on Violence Prevention research for two years. I have been mentored by Dr. Rochelle Dicker, founder of a hospital based violence prevention program in San Francisco. I am a member of the National Network for Hospital Based Violence Prevention Programs. My interest in public health research and advocacy for homeless people led me to develop this study.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.