Compared with poor adult patients with stable housing:
• Homeless adult patients were younger, disproportionately male and uninsured, and they suffered from much higher rates of depression and substance abuse.
• Over an average follow-up of more than two-and-a-half years, homeless adult patients had an 82 percent increased risk of developing kidney failure or dying. After demographic factors, substance abuse, and other medical conditions were taken into account, they had a 28 percent increased risk of developing kidney failure or dying.
• Also during follow-up, half of homeless adult patients visited the emergency department more than nine times and experienced more than five hospitalizations. Most housed patients experienced one or no emergency department visits or hospitalizations.
“Sadly, for most homeless persons, securing adequate shelter, food, and clothing often competes with regular healthcare and results in more frequent use of costly acute care services to manage chronic conditions,” said Dr. Hall. “Use of these acute care services might actually decline among the homeless when services such as transportation, social work, nutrition, and healthcare provider access become available following dialysis initiation.” Additional research is needed to see if such support services actually help homeless people receive appropriate and effective medical care, improve their health, and ultimately reduce public costs.
