The Impact of Housing Insecurity on Hospitalized Patients With Diagnosis of Cirrhosis: A Comparative Analysis Using Data from the National Inpatient Sample.

Abstract

Background: The impact of homelessness on clinical outcomes and health care utilization among hospitalized cirrhosis patients has not been well-characterized.

Methods: We conducted a cross-sectional study using the National Inpatient Sample (2016 to 2021) to analyze hospitalizations of adults with cirrhosis, comparing outcomes between those with and without homelessness. Demographic, clinical, and hospital-level characteristics were assessed, along with outcomes such as mortality and AMA discharges. Health care utilization metrics, including length of stay (LOS) and cost, were also evaluated, with multivariable regression used to adjust for confounders.

Results: Among 4,579,858 hospitalizations for cirrhosis, 109,640 (2.4%) involved homeless patients, who were younger (mean 53.5 vs. 60.6 y, P<0.001) and predominantly male (80.4% vs. 58.9%, P<0.001). Homeless patients had higher rates of alcohol use (73.5% vs. 30.9%, P<0.001), opioid use disorder (11.8% vs. 3.6%, P<0.001), and psychiatric comorbidities (62% vs. 37.4%, P<0.001). Hispanic and Native American patients were over-represented, while white patients were under-represented. Mortality was lower in homeless patients (aOR=0.49, 95% CI: 0.45-0.54, P<0.001). However, AMA discharges were significantly higher (9.6% vs. 2.7%, P<0.001). Homeless patients had longer hospital stays (mean 7.3 vs. 6.2 d, P<0.001) but lower per-day hospitalization costs ($2278 vs. $2859, P<0.001).

Conclusion: Despite lower mortality rates and cost per hospitalization day, high AMA discharge rates and prolonged hospital stays underscore the challenges to safe discharge among patients with cirrhosis experiencing homelessness.