The Homelessness Crisis and Burn Injuries: A Cohort Study

Abstract

<jats:title>Abstract</jats:title> <jats:p>The United States is facing a growing homelessness crisis. We characterize the demographics and outcomes of homeless patients who sustain burn injury and compare them to a cohort of domiciled patients. A retrospective cohort study was performed at the Los Angeles County + University of Southern California Regional Burn Center for consecutive acute burn admissions in adults from June 1, 2015, to December 31, 2018. Patients were categorized as either domiciled or homeless at the time of their injury. Prevalence rates were estimated using data from the regional homeless count. From 881 admissions, 751 (85%) had stable housing and 130 (15%) were homeless. The rate of burn injury requiring hospitalization for homeless adults was estimated at 88 per 100,000 persons. Homeless patients had a significantly larger median burn size (7 vs 5%, P &amp;lt; .05) and a greater rate of flame burns (68 vs 42%, P &amp;lt; .001). For the homeless, rates of assault and self-inflicted injury were 4- (18 vs 4%, P &amp;lt; .001) and 2-fold higher (9 vs 4%, P &amp;lt; .001), respectively. Homeless patients had higher rates of mental illness (32 vs 12%, P &amp;lt; .001) and substance abuse (88 vs 22%, P &amp;lt; .001), and were less likely to follow-up as outpatients (54 vs 87%, P &amp;lt; .001). There was no difference in mortality. Homeless patients had a longer median length of stay (LOS; 11 vs 7 days, P &amp;lt; .001) without significant differences in LOS per percentage TBSA. Homeless individuals should be considered a high-risk population for burn injury. This distinction serves as a call to action for the development of burn prevention strategies.</jats:p>

A scoping review of surgical care for people experiencing homelessness: prevalence, access, and disparities

“… 124 For example, PEH being reported as more likely to leave against medical advice and being over-represented in traumatic injuries can contribute to a negative perception of PEH. 19 – 21 , 38 , 45 , 72 Data suggest the phenomenon of negative counter-transference in caring for PEH can develop as early as during training. 124 , 125 If left unchecked, negative stereotypes, bias, and perceptions can affect patient care, research, and advocacy efforts for this population.…”

“…18 The agematched standard ized mortality rates for PEH in highincome countries are typically 2-5 times those of the general population. 15 Housing instability is associated with increased exposure to violence, assault, and unintentional injury, 15,19 and PEH are overrepresented among populations with traumatic and exposure injuries such as traumatic brain injury, 20 burns, 21 and facial fractures, 19 all of which are conditions that often require surgical care. The surgical needs of PEH are not well documented, yet housing status affects the approach to surgical care along its entire continuum from preopera tive preparation to surgical decisionmaking and post operative care.…”

Injury Patterns and Hospital Admission After Trauma Among People Experiencing Homelessness

“…[30][31][32][33] Prior studies have demonstrated that burns and exposure-related injury were common among PEH. [34][35][36] However, these studies were single center or city focused. Exposure to different mechanisms of…”

“…Structural variables, such as lack of affordable housing, are important factors associated with homelessness, and vulnerabilities such as mental illness and substance use disorder are well documented individual-level risk factors for both homelessness and traumatic injury . Prior studies have demonstrated that burns and exposure-related injury were common among PEH . However, these studies were single center or city focused.…”