The following is a summary of “Healthcare Disparities Among Homeless Patients Hospitalized With Gastrointestinal Bleeding,” published in the August 2023 issue of the Clinical Gastroenterology by Subramanian et al.

Evaluate outcomes among homeless individuals admitted with gastrointestinal (GI) bleeding, encompassing overall mortality and rates of endoscopic intervention. The frequency of hospitalizations among individuals experiencing homelessness has exhibited a consistent upward trend since at least 2007. However, this patient population needs more gastrointestinal (GI) outcomes knowledge. The 2010-2014 Healthcare Utilization Project (HCUP) State Inpatient Databases from New York and Florida were utilized to identify adult patients admitted with a primary diagnosis of acute gastrointestinal (GI) bleeding in the upper or lower GI tract. Patients experiencing homelessness were matched with non-homeless patients at a ratio of 1:3 using a propensity-score greedy-matched algorithm. 

The primary outcome (mortality due to any cause during the hospital stay) and additional outcomes (readmission rates within 30 days, utilization of endoscopy procedures, duration of hospital stay, and overall hospitalization costs) were assessed and compared. Researchers conducted a matching process to pair 4,074 patients experiencing homelessness with 12,222 patients who do not experience homelessness. The hospitalizations of individuals experiencing homelessness were primarily concentrated in 113 out of 428 hospitals, accounting for 26.4% of the total hospitalizations. Individuals experiencing homelessness exhibited a higher propensity for youthfulness, male gender, African American or Hispanic ethnicity, and reliance on Medicaid for healthcare coverage. Homeless individuals showed a notably increased likelihood of all-cause inpatient mortality compared to non-homeless patients admitted with gastrointestinal bleeding (odds ratio 1.37, 95% CI 1.11-1.69). 

The rates of endoscopy utilization were found to be lower for both upper gastrointestinal (GI) bleeding (odds ratio [OR] 0.62, 95% confidence interval [CI] 0.55-0.71) and lower GI bleeding (OR 0.76, 95% CI 0.68-0.85). However, the rates of upper endoscopy within the first 24 hours were similar (OR 1.11, 95% CI 1.00-1.23). The hospitalization expenses were lower in the homeless group than in the non-homeless group ($9,715 vs. $12,173, P<0.001). However, the readmission rate for any cause within 30 days was significantly higher in the homeless group (14.9% vs. 18.4%, P<0.001). Patients experiencing gastrointestinal bleeding who are homeless and require hospitalization encounter disparities in their medical care, which can result in elevated mortality rates and reduced utilization of endoscopy procedures.

Source: journals.lww.com/jcge/Abstract/2023/08000/Healthcare_Disparities_Among_Homeless_Patients.9.aspx