The Epidemiology of the Homeless Population and Its Impact on an Urban Emergency Department

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Abstract
Objectives: 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. Inclusion criteria: 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. Exclusion criteria: 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 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.