An analysis of homeless patients in the United States requiring ICU admission

Abstract

Purpose: To assess how homelessness impacts mortality and length of stay (LOS) among select the intensive care unit (ICU) patients.

Methods: We used ICD-9 code V60.0 to identify homeless patients using the Premier Perspective Database from January 2010 to June 2011. We identified three subpopulations who received critical care services using ICD-9 and Medicare Severity Diagnosis Related Groups (MS-DRG) codes: patients with a diagnosis of sepsis who were treated with antibiotics by Day 2, patients with an alcohol or drug related MS-DRG, and patients with a diabetes related MS-DRG. We used multivariable logistic regression to predict mortality and multivariable generalized estimating equations to predict hospital and ICU LOS.

Results: 781,540 hospitalizations met inclusion criteria; 2278 (0.3%) were homeless. We found homelessness had no significant adjusted association with mortality among sepsis patients, but was associated with substantially longer hospital LOS: (3.7 days longer; 95% CI (1.7, 5.7, p < .001). LOS did not differ in the Diabetes or Alcohol and Drug related DRG groups.

Conclusions: Critically ill homeless patients with sepsis had longer hospital LOS but similar ICU LOS and mortality risk compared to non-homeless patients. Homelessness was not associated with increased LOS in the diabetes or alcohol and drug related groups.

Keywords: Alcoholism; Critical care outcomes; Critical illness; Diabetes complications; Homelessness; Sepsis.