title: The effects of homelessness on Veterans' health care service use: an evaluation of independence from comorbidities.
abstract: OBJECTIVE
  This study evaluates the prevalence of Multiple Comorbid Chronic Disease (MCCD) within homeless and non-homeless Veterans and the association between MCCD and inpatient medical care.
  
  
  METHODS
  All individuals seen in the VA North Texas Health Care System between October 1, 2009 and September 30, 2010 (n = 102,034) were evaluated. Homelessness during the year and the number of common chronic diseases were evaluated for an association with likelihood of medical and psychiatric hospitalizations, bed days of care, inpatient substance treatment, rehabilitation admissions, and emergency department visits.
  
  
  RESULTS
  Homeless Veterans had higher all-cause mortality rates and rates of use of almost all resources after controlling for chronic disease burden using the Charlson Comorbidity Index, psychiatric illnesses, substance use disorders, and demographic variables.
  
  
  CONCLUSIONS
  Homelessness Veterans are vulnerable to a high use of resources and mortality, independent of medical and psychiatric conditions. This finding should focus additional attention on reducing homelessness.
authors.affiliation: VA North Texas Health Care System, USA; University of Texas Southwestern Medical Center, USA. Electronic address: James.lepage@va.gov.
authors.forename: J P
authors.initials: JP
authors.lastname: LePage
authors.affiliation: VA North Texas Health Care System, USA. Electronic address: Ledjona.bradshaw@va.gov.
authors.forename: L D
authors.initials: LD
authors.lastname: Bradshaw
authors.affiliation: University of Texas at Arlington, USA. Electronic address: cipherconsulting@earthlink.net.
authors.forename: D J
authors.initials: DJ
authors.lastname: Cipher
authors.affiliation: Dallas VA Research Corporation, USA. Electronic address: April.crawford@va.gov.
authors.forename: A M
authors.initials: AM
authors.lastname: Crawford
authors.affiliation: VA North Texas Health Care System, USA; University of Texas Southwestern Medical Center, USA. Electronic address: Dina.hoosyhar@va.gov.
authors.forename: D
authors.initials: D
authors.lastname: Hoosyhar
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease / Q000453:epidemiology*; D015897:Comorbidity; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data*; D006703:Ill-Housed Persons / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D013781:Texas / Q000453:epidemiology; D014728:Veterans / Q000706:statistics & numerical data*; D058014:Veterans Health / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: Bed days of care; Chronic medical diseases; Emergency department treatment; Homelessness; Hospitalization; Veterans