title: Predictors of medical or surgical and psychiatric hospitalizations among a population-based cohort of homeless adults.
abstract: OBJECTIVE
  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.
authors.affiliation: Catharine Chambers, Shirley Chiu, and Stephen W. Hwang are with the Centre for Research on Inner City Health, part of the Keenan Research Centre in the Li Ka Shing Knowledge Institute at St Michael's Hospital, Toronto, Ontario. Marko Katic and Alex Kiss are with the Department of Research Design and Biostatistics, Sunnybrook Health Sciences Centre, Toronto. Donald A. Redelmeier is with the Institute for Clinical Evaluative Sciences, Sunnybrook Health Sciences Centre, Toronto. Wendy Levinson is with the Department of Medicine, University of Toronto, Toronto.
authors.forename: Catharine
authors.initials: C
authors.lastname: Chambers
authors.forename: Marko
authors.initials: M
authors.lastname: Katic
authors.forename: Shirley
authors.initials: S
authors.lastname: Chiu
authors.forename: Donald A
authors.initials: DA
authors.lastname: Redelmeier
authors.forename: Wendy
authors.initials: W
authors.lastname: Levinson
authors.forename: Alex
authors.initials: A
authors.lastname: Kiss
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Hwang
mesh_terms: D015331:Cohort Studies; D005260:Female; D006304:Health Status; D006703:Ill-Housed Persons / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006778:Hospitals, Psychiatric / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008603:Mental Health; D009864:Ontario / Q000453:epidemiology; D012307:Risk Factors; D012944:Social Support; D012959:Socioeconomic Factors; D019966:Substance-Related Disorders / Q000453:epidemiology