Hospital readmission among people experiencing homelessness in England: a cohort study of 2772 matched homeless and housed inpatients

Dan  Lewer; Dee Menezes; Michelle Cornes; Ruth M Blackburn; Richard Byng; Michael Clark; Spiros Denaxas; Hannah Evans; James Fuller; Nigel Hewett; Alan Kilmister; Serena Luchenski; Jill Manthorpe; Martin McKee; Joanne Neale; Alistair Story; Michela Tinelli; Martin Whiteford; Fatima Wurie; Alexi Yavlinsky; Andrew Hayward; Robert W Aldridge

doi:10.1136/jech-2020-215204

Hospital readmission among people experiencing homelessness in England: a cohort study of 2772 matched homeless and housed inpatients

Dan Lewer, Dee Menezes, Michelle Cornes, Ruth M Blackburn, Richard Byng, Michael Clark, Spiros Denaxas, Hannah Evans, James Fuller, Nigel Hewett, Alan Kilmister, Serena Luchenski, Jill Manthorpe, Martin McKee, Joanne Neale, Alistair Story, Michela Tinelli, Martin Whiteford, Fatima Wurie, Alexi YavlinskyAndrew Hayward, Robert W Aldridge

Research output: Contribution to journal › Article › peer-review

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Abstract

Background Inpatients experiencing homelessness are often discharged to unstable accommodation or the street, which may increase the risk of readmission. Methods We conducted a cohort study of 2772 homeless patients discharged after an emergency admission at 78 hospitals across England between November 2013 and November 2016. For each individual, we selected a housed patient who lived in a socioeconomically deprived area, matched on age, sex, hospital, and year of discharge. Counts of emergency readmissions, planned readmissions, and Accident and Emergency (A&E) visits post-discharge were derived from national hospital databases, with a median of 2.8 years of follow-up. We estimated the cumulative incidence of readmission over 12 months, and used negative binomial regression to estimate rate ratios. Results After adjusting for health measured at the index admission, homeless patients had 2.49 (95% CI 2.29 to 2.70) times the rate of emergency readmission, 0.60 (95% CI 0.53 to 0.68) times the rate of planned readmission and 2.57 (95% CI 2.41 to 2.73) times the rate of A&E visits compared with housed patients. The 12-month risk of emergency readmission was higher for homeless patients (61%, 95% CI 59% to 64%) than housed patients (33%, 95% CI 30% to 36%); and the risk of planned readmission was lower for homeless patients (17%, 95% CI 14% to 19%) than for housed patients (30%, 95% CI 28% to 32%). While the risk of emergency readmission varied with the reason for admission for housed patients, for example being higher for admissions due to cancers than for those due to accidents, the risk was high across all causes for homeless patients. Conclusions Hospital patients experiencing homelessness have high rates of emergency readmission that are not explained by health. This highlights the need for discharge arrangements that address their health, housing and social care needs.

Original language	English
Pages (from-to)	681-688
Number of pages	8
Journal	Journal of Epidemiology and Community Health
Volume	75
Issue number	7
DOIs	https://doi.org/10.1136/jech-2020-215204
Publication status	Published - 5 Jan 2021

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Lewer, D., Menezes, D., Cornes, M., Blackburn, R. M., Byng, R., Clark, M., Denaxas, S., Evans, H., Fuller, J., Hewett, N., Kilmister, A., Luchenski, S., Manthorpe, J., McKee, M., Neale, J., Story, A., Tinelli, M., Whiteford, M., Wurie, F., ... Aldridge, R. W. (2021). Hospital readmission among people experiencing homelessness in England: a cohort study of 2772 matched homeless and housed inpatients. Journal of Epidemiology and Community Health, 75(7), 681-688. https://doi.org/10.1136/jech-2020-215204

@article{5892cf362ac94ad58d2ff7d8ba535a30,

title = "Hospital readmission among people experiencing homelessness in England: a cohort study of 2772 matched homeless and housed inpatients",

abstract = "Background Inpatients experiencing homelessness are often discharged to unstable accommodation or the street, which may increase the risk of readmission. Methods We conducted a cohort study of 2772 homeless patients discharged after an emergency admission at 78 hospitals across England between November 2013 and November 2016. For each individual, we selected a housed patient who lived in a socioeconomically deprived area, matched on age, sex, hospital, and year of discharge. Counts of emergency readmissions, planned readmissions, and Accident and Emergency (A&E) visits post-discharge were derived from national hospital databases, with a median of 2.8 years of follow-up. We estimated the cumulative incidence of readmission over 12 months, and used negative binomial regression to estimate rate ratios. Results After adjusting for health measured at the index admission, homeless patients had 2.49 (95% CI 2.29 to 2.70) times the rate of emergency readmission, 0.60 (95% CI 0.53 to 0.68) times the rate of planned readmission and 2.57 (95% CI 2.41 to 2.73) times the rate of A&E visits compared with housed patients. The 12-month risk of emergency readmission was higher for homeless patients (61%, 95% CI 59% to 64%) than housed patients (33%, 95% CI 30% to 36%); and the risk of planned readmission was lower for homeless patients (17%, 95% CI 14% to 19%) than for housed patients (30%, 95% CI 28% to 32%). While the risk of emergency readmission varied with the reason for admission for housed patients, for example being higher for admissions due to cancers than for those due to accidents, the risk was high across all causes for homeless patients. Conclusions Hospital patients experiencing homelessness have high rates of emergency readmission that are not explained by health. This highlights the need for discharge arrangements that address their health, housing and social care needs.",

author = "Dan Lewer and Dee Menezes and Michelle Cornes and Blackburn, {Ruth M} and Richard Byng and Michael Clark and Spiros Denaxas and Hannah Evans and James Fuller and Nigel Hewett and Alan Kilmister and Serena Luchenski and Jill Manthorpe and Martin McKee and Joanne Neale and Alistair Story and Michela Tinelli and Martin Whiteford and Fatima Wurie and Alexi Yavlinsky and Andrew Hayward and Aldridge, {Robert W}",

note = "Funding Information: RMB is supported by a UK Research and Innovation Fellowship funded by a grant from the Medical Research Council (MR/S003797/1). SL is funded by NIHR (ICA-CDRF-2016-02-042). RB is supported by the NIHR Applied Research Collaboration (ARC) South West Peninsula and JM is supported by the NIHR ARC South London. RWA is supported by Wellcome through a Wellcome Clinical Research Career Development Fellowship (206602). This article is based on independent research commissioned and funded by the NIHR Health Service and Delivery Programme. Funding Information: Funding This study was supported by the National Institute for Health Research (NIHR) (Project number: 13/156/10 to HS & DR). We also acknowledge the support from the Health Data Research (HDR) UK which receives its funding from HDR UK funded by the UK Medical Research Council, Engineering and Physical Sciences Research Council, Economic and Social Research Council, Department of Health and Social Care (England), Chief Scientist Office of the Scottish Government Health and Social Care Directorates, Health and Social Care Research and Development Division (Welsh Government), Public Health Agency (Northern Ireland), British Heart Foundation (BHF) and the Wellcome Trust. AH{\textquoteright}s salary is provided by Central and North West London NHS Community Trust. AS is funded by UCLH Foundation Trust. DL is funded by an NIHR Doctoral Research Fellowship (DRF-2018-11-ST2-016). JN is part-funded by the NIHR Biomedical Research Centre for Mental Health at South London and Maudsley NHS Foundation Trust and King{\textquoteright}s College London. Publisher Copyright: {\textcopyright} Copyright: Copyright 2021 Elsevier B.V., All rights reserved.",

year = "2021",

month = jan,

day = "5",

doi = "10.1136/jech-2020-215204",

language = "English",

volume = "75",

pages = "681--688",

journal = "Journal of Epidemiology and Community Health",

issn = "1470-2738",

publisher = "BMJ Publishing Group",

number = "7",

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Lewer, D, Menezes, D, Cornes, M, Blackburn, RM, Byng, R, Clark, M, Denaxas, S, Evans, H, Fuller, J, Hewett, N, Kilmister, A, Luchenski, S, Manthorpe, J, McKee, M, Neale, J, Story, A, Tinelli, M, Whiteford, M, Wurie, F, Yavlinsky, A, Hayward, A & Aldridge, RW 2021, 'Hospital readmission among people experiencing homelessness in England: a cohort study of 2772 matched homeless and housed inpatients', Journal of Epidemiology and Community Health, vol. 75, no. 7, pp. 681-688. https://doi.org/10.1136/jech-2020-215204

TY - JOUR

T1 - Hospital readmission among people experiencing homelessness in England: a cohort study of 2772 matched homeless and housed inpatients

AU - Lewer, Dan

AU - Menezes, Dee

AU - Cornes, Michelle

AU - Blackburn, Ruth M

AU - Byng, Richard

AU - Clark, Michael

AU - Denaxas, Spiros

AU - Evans, Hannah

AU - Fuller, James

AU - Hewett, Nigel

AU - Kilmister, Alan

AU - Luchenski, Serena

AU - Manthorpe, Jill

AU - McKee, Martin

AU - Neale, Joanne

AU - Story, Alistair

AU - Tinelli, Michela

AU - Whiteford, Martin

AU - Wurie, Fatima

AU - Yavlinsky, Alexi

AU - Hayward, Andrew

AU - Aldridge, Robert W

N1 - Funding Information: RMB is supported by a UK Research and Innovation Fellowship funded by a grant from the Medical Research Council (MR/S003797/1). SL is funded by NIHR (ICA-CDRF-2016-02-042). RB is supported by the NIHR Applied Research Collaboration (ARC) South West Peninsula and JM is supported by the NIHR ARC South London. RWA is supported by Wellcome through a Wellcome Clinical Research Career Development Fellowship (206602). This article is based on independent research commissioned and funded by the NIHR Health Service and Delivery Programme. Funding Information: Funding This study was supported by the National Institute for Health Research (NIHR) (Project number: 13/156/10 to HS & DR). We also acknowledge the support from the Health Data Research (HDR) UK which receives its funding from HDR UK funded by the UK Medical Research Council, Engineering and Physical Sciences Research Council, Economic and Social Research Council, Department of Health and Social Care (England), Chief Scientist Office of the Scottish Government Health and Social Care Directorates, Health and Social Care Research and Development Division (Welsh Government), Public Health Agency (Northern Ireland), British Heart Foundation (BHF) and the Wellcome Trust. AH’s salary is provided by Central and North West London NHS Community Trust. AS is funded by UCLH Foundation Trust. DL is funded by an NIHR Doctoral Research Fellowship (DRF-2018-11-ST2-016). JN is part-funded by the NIHR Biomedical Research Centre for Mental Health at South London and Maudsley NHS Foundation Trust and King’s College London. Publisher Copyright: © Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

PY - 2021/1/5

Y1 - 2021/1/5

N2 - Background Inpatients experiencing homelessness are often discharged to unstable accommodation or the street, which may increase the risk of readmission. Methods We conducted a cohort study of 2772 homeless patients discharged after an emergency admission at 78 hospitals across England between November 2013 and November 2016. For each individual, we selected a housed patient who lived in a socioeconomically deprived area, matched on age, sex, hospital, and year of discharge. Counts of emergency readmissions, planned readmissions, and Accident and Emergency (A&E) visits post-discharge were derived from national hospital databases, with a median of 2.8 years of follow-up. We estimated the cumulative incidence of readmission over 12 months, and used negative binomial regression to estimate rate ratios. Results After adjusting for health measured at the index admission, homeless patients had 2.49 (95% CI 2.29 to 2.70) times the rate of emergency readmission, 0.60 (95% CI 0.53 to 0.68) times the rate of planned readmission and 2.57 (95% CI 2.41 to 2.73) times the rate of A&E visits compared with housed patients. The 12-month risk of emergency readmission was higher for homeless patients (61%, 95% CI 59% to 64%) than housed patients (33%, 95% CI 30% to 36%); and the risk of planned readmission was lower for homeless patients (17%, 95% CI 14% to 19%) than for housed patients (30%, 95% CI 28% to 32%). While the risk of emergency readmission varied with the reason for admission for housed patients, for example being higher for admissions due to cancers than for those due to accidents, the risk was high across all causes for homeless patients. Conclusions Hospital patients experiencing homelessness have high rates of emergency readmission that are not explained by health. This highlights the need for discharge arrangements that address their health, housing and social care needs.

AB - Background Inpatients experiencing homelessness are often discharged to unstable accommodation or the street, which may increase the risk of readmission. Methods We conducted a cohort study of 2772 homeless patients discharged after an emergency admission at 78 hospitals across England between November 2013 and November 2016. For each individual, we selected a housed patient who lived in a socioeconomically deprived area, matched on age, sex, hospital, and year of discharge. Counts of emergency readmissions, planned readmissions, and Accident and Emergency (A&E) visits post-discharge were derived from national hospital databases, with a median of 2.8 years of follow-up. We estimated the cumulative incidence of readmission over 12 months, and used negative binomial regression to estimate rate ratios. Results After adjusting for health measured at the index admission, homeless patients had 2.49 (95% CI 2.29 to 2.70) times the rate of emergency readmission, 0.60 (95% CI 0.53 to 0.68) times the rate of planned readmission and 2.57 (95% CI 2.41 to 2.73) times the rate of A&E visits compared with housed patients. The 12-month risk of emergency readmission was higher for homeless patients (61%, 95% CI 59% to 64%) than housed patients (33%, 95% CI 30% to 36%); and the risk of planned readmission was lower for homeless patients (17%, 95% CI 14% to 19%) than for housed patients (30%, 95% CI 28% to 32%). While the risk of emergency readmission varied with the reason for admission for housed patients, for example being higher for admissions due to cancers than for those due to accidents, the risk was high across all causes for homeless patients. Conclusions Hospital patients experiencing homelessness have high rates of emergency readmission that are not explained by health. This highlights the need for discharge arrangements that address their health, housing and social care needs.

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U2 - 10.1136/jech-2020-215204

DO - 10.1136/jech-2020-215204

M3 - Article

SN - 1470-2738

VL - 75

SP - 681

EP - 688

JO - Journal of Epidemiology and Community Health

JF - Journal of Epidemiology and Community Health

IS - 7

ER -

Hospital readmission among people experiencing homelessness in England: a cohort study of 2772 matched homeless and housed inpatients

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