Health Care Utilization of Homeless Minors With Diabetes in New York State From 2009 to 2014

Abstract

<jats:p>&lt;i&gt;Objective&lt;/i&gt;: This study aims to describe differences in healthcare utilization between homeless and non-homeless minors with diabetes mellitus (DM). &lt;p&gt;&lt;i&gt;Research Design and Methods&lt;/i&gt;: Data from the Healthcare Cost and Utilization Project’s Statewide Inpatient Database from New York for years 2009-2014 was examined to identify pediatric patients &lt;18 years old with DM. Outcomes of interest included: hospitalization rate, in-hospital mortality, admission through the emergency department (ED), diabetic ketoacidosis (DKA), hospitalization cost, and lengths of stay (LOS). Other variables of interest included: age group, race/ethnicity, insurance type, and year. Multivariate logistic regression models were used for in-hospital mortality, admission through ED, and DKA. Log-transformed linear regression models were used for hospitalization cost, and negative binomial regression models were used for LOS.&lt;/p&gt; &lt;p&gt;&lt;i&gt;Results&lt;/i&gt;: A total of 643 homeless and 10,559 non-homeless cases were identified. The hospitalization rate was higher among homeless minors, with 3.64 per 1,000 homeless population and 0.38 per 1,000 non-homeless population, respectively. A statistically significant higher readmission rate was detected among homeless minors (20.4% among homeless and 14.1% among non-homeless, &lt;i&gt;p&lt;/i&gt; &lt;0.01). Lower rates of DKA (OR 0.75, &lt;i&gt;p&lt;/i&gt;=0.02), hospitalization costs (point estimate 0.88,&lt;i&gt; p&lt;/i&gt; &lt;.01), and longer LOS (Incidence Rate Ratio (IRR) 1.20, &lt;i&gt;p&lt;/i&gt; &lt;0.01) were detected among homeless minors compared to non-homeless minors. &lt;/p&gt; &lt;p&gt;&lt;i&gt;Conclusions&lt;/i&gt;: This study found that among minors with DM, those who are homeless experience a higher hospitalization rate than the non-homeless. Housing instability, among other environmental factors, may be targeted for intervention to improve health outcomes.&lt;/p&gt;</jats:p>

Does Social Capital Promote Health?

“…Social capital has been empirically linked to both reduced mortality (Borgonovi et al, 2021 ; Jong et al, 2017 ; Riumallo-Herl et al, 2014 ) and increased self-rated health (Kim & Cho, 2016 ; Mayer, 2017 ; Lu & Zhang, 2019 ). Social capital has also been linked to various health-related behaviours, such as smoking, drinking, leisure-time physical activity and dietary habits (Timo-Kolja & Bart, 2015 ; Stewart et al, 2017 ; Kang et al, 2018 ; Sakai-Bizmark et al, 2020 ) and to the prevalence of various diseases, such as cancer (Shelton et al, 2016 ), heart disease (Fang et al, 2017 ), HIV (Afzali et al, 2015 ), depression (Lee et al, 2019 ) and COVID-19 (Pitas & Ehmer, 2020 ).…”

Characteristics of People with Type I or Type II Diabetes with and without a History of Homelessness: A Population-based Cohort Study

“…Our ability to study health outcomes at the population level has improved with advancements in administrative data linkage; however, the application of these data to study homelessness has been limited. One study using State Inpatient Databases reported that youth with diabetes experiencing homelessness have higher readmission rates and length of hospital stay, and lower rates of diabetic ketoacidosis and hospital costs than non-homeless youth with diabetes in New York (16). Another study using Veterans Health Administration data showed higher odds of elevated glycated hemoglobin levels (>8%) for Veterans with diabetes who are homeless compared to housed (17).…”