The epidemiology of the homeless population and its impact on an urban emergency department.
OBJECTIVE
To characterize the homeless adult population of an urban emergency department (ED) and study the medical, psychiatric, and social factors that contribute to homelessness.


METHODS
A prospective, case-control survey of all homeless adult patients presenting to an urban, tertiary care ED and a random set of non-homeless controls over an eight-week period during summer 1999. Research assistants administered a 50-item questionnaire and were trained in assessing dentition and triceps skin-fold thickness.


METHODS
all homeless adults who consented to participate. Homelessness was defined as being present for any person not residing at a private address, group home, or drug treatment program. Randomly selected controls were concurrently enrolled with a 3:1 homeless:control rate.


METHODS
critically ill, injured, or incapacitated patients, or patients <21 years of age. Univariate analysis with appropriate statistical tests was used. The Mantel-Haenszel test was used to adjust for population differences.


RESULTS
Two hundred fifty-two homeless subjects and 88 controls were enrolled. Data are presented for homeless vs control patients, and all p-values were <0.01. Odds ratios (ORs) with 95% confidence intervals (95% CIs) are given where appropriate: mean age (+/-SD) = 42 +/- 10 vs 48 +/- 13; male gender 95% vs 54% (OR = 17; 95% CI = 8 to 37); history of (hx) tuberculosis 49% vs 15% (OR = 2.5; 95% CI = 1.2 to 3); hx HIV infection 35% vs 13% (OR = 3.8; 95% CI = 1.8 to 8); hx penetrating trauma 62% vs 16% (OR = 8.62; 95% CI = 4.4 to 17.1); hx depression 70% vs 15% (OR = 13.4; 95% CI = 6.7 to 27); hx schizophrenia 27% vs 7% (OR = 5.1; 95% CI = 2.0 to 14); hx alcoholism 81% vs 15% (OR = 24; 95% CI = 12 to 49); significant tooth loss (>3) 43% vs 18% (OR = 3.3; 95% CI = 1.8 to 6.4); percentage of body fat 16.5% vs 19.7%; hx social isolation (no weekly social contacts) 81% vs 11% (OR = 33.3; 95% CI = 14 to 100); mean number of ED visits/year 6.0 vs 1.6.


CONCLUSIONS
In the study population homelessness was associated with a history of significantly higher rates of infectious disease, ethanol and substance use, psychiatric illness, social isolation, and rates of ED utilization.
D'Amore
J
J
New York University-Bellevue Department of Emergency Medicine, New York, NY, USA. jzd29@hotmail.com
Hung
O
O
Chiang
W
W
Goldfrank
L
L
D000328:Adult; D016022:Case-Control Studies; D003625:Data Collection; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006295:Health Resources / Q000706:statistics & numerical data; D006703:Ill-Housed Persons / Q000523:psychology / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D009519:New York City / Q000453:epidemiology; D011159:Population Surveillance; D015995:Prevalence; D011446:Prospective Studies; D012306:Risk; D012959:Socioeconomic Factors; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000523:psychology; D014504:Urban Health; D014505:Urban Population / Q000706:statistics & numerical data