title: Correlates of hospital use in homeless and unstably housed women: the role of physical health and pain.
abstract: OBJECTIVE
  To examine correlates of emergency department (ED) use and hospitalizations in a community-based cohort of homeless and unstably housed women, with a focus on the role of physical health and pain.
  
  
  METHODS
  We conducted a cross-sectional analysis of baseline survey results from a study of homeless and unstably housed women in San Francisco. Primary outcomes were any self-reported ED visit and inpatient hospitalization over the prior 6 months. Primary independent variables of interest were self-reported physical health status, as measured by the Short Form-12 (SF-12), and bodily pain. Other potential covariates were organized using the Gelberg-Andersen Behavioral Model for Vulnerable Populations. Standard bivariate and multivariable logistic regression techniques were used.
  
  
  RESULTS
  Three hundred homeless and unstably housed women were included in the study, of whom 37.7% reported having an ED visit and 23.0% reported being hospitalized in the prior 6 months. Mean SF-12 physical health scores indicated poorer than average health compared with the U.S. norm. Most women (79.3%) reported at least some limitation in their daily activities owing to pain. In adjusted analyses, moderate and high levels of bodily pain were significantly correlated with ED visits (odds ratio [OR], 2.92 and OR, 2.57) and hospitalizations (OR, 6.13 and OR, 2.49). As SF-12 physical health scores decreased, indicating worse health, the odds of ED use increased. Predisposing, enabling, and additional need factors did not mediate these associations.
  
  
  CONCLUSIONS
  Physical health and bodily pain are important correlates of ED visits and hospitalizations among homeless and unstably housed women. Interventions to reduce ED use among women who are homeless should address the high levels of pain in this population.
authors.affiliation: Department of Emergency Medicine and Department of Population Health, NYU School of Medicine, Bellevue Hospital Center, New York, New York; U.S. Department of Veterans Affairs. Electronic address: kelly.doran@nyumc.org.
authors.forename: Kelly M
authors.initials: KM
authors.lastname: Doran
authors.affiliation: Department of Psychiatry, University of California, San Francisco, California.
authors.forename: Martha
authors.initials: M
authors.lastname: Shumway
authors.affiliation: Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut.
authors.forename: Rani A
authors.initials: RA
authors.lastname: Hoff
authors.affiliation: Division of General Internal Medicine, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York.
authors.forename: Oni J
authors.initials: OJ
authors.lastname: Blackstock
authors.affiliation: Department of Medicine, University of California, San Francisco, San Francisco, California.
authors.forename: Samantha E
authors.initials: SE
authors.lastname: Dilworth
authors.affiliation: Department of Medicine, University of California, San Francisco, San Francisco, California.
authors.forename: Elise D
authors.initials: ED
authors.lastname: Riley
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006304:Health Status; D006703:Ill-Housed Persons / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006798:Housing / Q000706:statistics & numerical data*; D006801:Humans; D010146:Pain; D012044:Regression Analysis; D012495:San Francisco; D012959:Socioeconomic Factors