Emergency Department Visits By Homeless and Housed Young Adults in the United States

Background and Purpose: The period between the late teenage years into the mid-twenties has received recognition as having unique developmental characteristics. Experiences during this period have implications for future health and well-being. Accordingly, there has been increased attention on the health care needs and health care utilization of young adults within the United States. Yet, while research on health needs and health care utilization for young adults is increasing, we know less about homeless young adults. This gap is concerning because a recent report suggests that one in 10 young adults in the United States experiences homelessness at some point during the year. The purpose of this study was to increase understanding of Emergency Department (ED) visits among homeless young adults within the United States. First, we examined characteristics of ED visits made by homeless young adults as compared to their housed counterparts. Then, we investigated factors that may explain the differences in the characteristics of ED visits made by homeless versus housed young adults.

Methods: Data for this study were obtained from the 2011-2015 National Hospital Ambulatory Medical Care Survey (NHAMCS). NHAMCS is an annual national representative survey of ambulatory care in hospital emergency and outpatient departments in the United States conducted by the Centers for Disease Control and Prevention. The initial sample for this study included all ED visits made by young adults ages 18 to 29 (Unweighted N=26,206). For bivariate and multivariable analyses, the sample was restricted to homeless and housed young adults using the patients’ housing status variable (Unweighted N=25,068). Sampling weights and complex survey designs were taken into account using the svy package in Stata 15.1.

Results: ED visits by homeless young adults were distinguished from ED visits by housed young adults in terms of gender, region, payment sources, and triage level. Further, ED visits made by homeless young adults were more likely related to mental health reasons and suicide, whereas ED visits made by housed young adults were more likely for respiratory and gastrointestinal reasons. Results from multivariable analyses showed that service characteristics of ED visits were also different for homeless young adults. Homeless young adults had lower odds of being referred to a physician for follow-up and had longer stays in the ED, after adjusting for sociodemographic, clinical, and service characteristics.

Conclusions and Implications: This study highlighted differences in ED utilization for homeless and housed young adults. Further, results indicated that services received in the ED also differed according to housing status. Literature suggests that homeless youth and adults perceive that they are treated differently than housed individuals by healthcare professionals. Findings from this study may support those perceptions because they suggest that homeless young adults may receive different treatment in the ED. Additional research is needed to increase understanding of homeless young adults’ ED utilization.