Epidemiological analysis of emergency department utilization among homeless persons presenting with injuries

Background: The aim of the present study was to examine emergency department (ED) utilization for injuries among homeless persons in the U.S. While homeless populations frequent ED's for healthcare, little is known about injury related incidents at the national level. Methods: We analyzed a nationally representative sample of patients presenting to ED settings in the U.S. with data obtained from the 2009-2010 ED module of the National Hospital Ambulatory Medical Care Survey. Descriptive epidemiological analyses and logistic regression analyses were employed to examine injuries among homeless populations, as well as to compare clinical and demographic characteristics of visits by resident status. Data were analyzed using STATA MP/11. Results: Findings indicated that homeless persons made 663,000 visits annually to emergency departments. Among homeless persons, 51% of the ED visits were indicated for injuries, with the majority being for unintentional injuries (36.3%; 95% CI 30.2-42.8)) and self-inflicted injuries (10.1%; 95% CI: 6.4-45.6). Results of logistic regression analyses revealed that compared to non-homeless populations, homeless persons were significantly more likely to visit ED's for both unintentional and intentional (self-inflicted or assault) related injuries. Injured homeless persons were also more likely to present with comorbid conditions of substance use and psychiatric disorders. Conclusions: Homeless persons represent a vulnerable population at greater risk of presenting to ED's for intentional and unintentional injuries. Comorbid conditions likely compound this problem and will be discussed.