Between 2020 and 2022, there has been a slight increase in the number of persons experiencing homelessness in the United States. There remains an overrepresentation of Black/African American, and indigenous individuals among this population. Compared to the general population, persons experiencing homelessness generally have higher rates of emergency department (ED) use. From 2019-2020, 73.5% of all hospital encounters for persons experiencing homelessness in California were in the ED. Persons experiencing homelessness often have limited access to primary care due to factors including high healthcare costs, perceived stigma, and competing priorities; therefore, they turn to the ED as their primary source of care. Persons experiencing homelessness experience higher rates of health conditions, which is a significant driver of ED use.

Methods

Data from California Department of Health Care Access and Information (HCAI) were used to analyze ED discharges among individuals who experienced homelessness in San Diego County. Discharges were unduplicated to identify the total number of individuals experiencing homelessness that were discharged from the ED in San Diego County from 2019-2021. The top primary diagnoses at discharge were identified for comparative analysis and to determine differences by gender, age, and race/ethnicity.

Results

In 2021, there were 35,344 ED discharges of persons experiencing homelessness in San Diego County. After un-duplicating records this represented a total of 11,383 homeless individuals discharged from San Diego County Emergency Departments in 2021. Close to 7% of all ED discharges of persons experiencing homelessness had a primary diagnosis of alcohol-related disorders. Over 5% of all ED discharges of persons experiencing homelessness had a primary diagnosis of schizophrenia spectrum and other psychotic disorders. Preliminary analysis showed significant differences in ED discharge primary diagnosis among individuals experiencing homelessness, when stratified by sex, age, and race/ethnicity. In 2021, Hispanic individuals experiencing homelessness in San Diego County were significantly more likely to be discharged from the ED with a primary diagnosis of COVID-19 (Hispanic OR = 1.76, 95% CI = 1.29-2.41) than White individuals experiencing homelessness who were discharged from the ED with a primary diagnosis of COVID-19, without adjusting for additional factors.

Conclusion

Analyzing ED discharges among persons experiencing homelessness in San Diego County can inform the public and local health jurisdiction to support positive public health outcomes. Understanding health disparities in our homeless population will help broaden access to health care and improve health outcomes among individuals experiencing homelessness in San Diego County.