Stephen W Hwang1, Catharine Chambers, Shirley Chiu, Marko Katic, Alex Kiss, Donald A Redelmeier, Wendy Levinson. 1. Stephen W. Hwang, Catharine Chambers, and Shirley Chiu are with the Centre for Research on Inner City Health, part of the Keenan Research Centre in the Li Ka Shing Knowledge Institute at St. Michael's Hospital, Toronto, Ontario. Marko Katic and Alex Kiss are with the Department of Research Design and Biostatistics, Sunnybrook Health Sciences Centre, Toronto. Donald A. Redelmeier is with the Institute for Clinical Evaluative Sciences, Sunnybrook Health Sciences Centre, Toronto. Wendy Levinson is with the Department of Medicine, University of Toronto.
Abstract
OBJECTIVES: We comprehensively assessed health care utilization in a population-based sample of homeless adults and matched controls under a universal health insurance system. METHODS: We assessed health care utilization by 1165 homeless single men and women and adults in families and their age- and gender-matched low-income controls in Toronto, Ontario, from 2005 to 2009, using repeated-measures general linear models to calculate risk ratios and 95% confidence intervals (CIs). RESULTS: Homeless participants had mean rates of 9.1 ambulatory care encounters (maximum = 141.1), 2.0 emergency department (ED) encounters (maximum = 104.9), 0.2 medical-surgical hospitalizations (maximum = 14.9), and 0.1 psychiatric hospitalizations per person-year (maximum = 4.8). Rate ratios for homeless participants compared with matched controls were 1.76 (95% CI = 1.58, 1.96) for ambulatory care encounters, 8.48 (95% CI = 6.72, 10.70) for ED encounters, 4.22 (95% CI = 2.99, 5.94) for medical-surgical hospitalizations, and 9.27 (95% CI = 4.42, 19.43) for psychiatric hospitalizations. CONCLUSIONS: In a universal health insurance system, homeless people had substantially higher rates of ED and hospital use than general population controls; these rates were largely driven by a subset of homeless persons with extremely high-intensity usage of health services.
OBJECTIVES: We comprehensively assessed health care utilization in a population-based sample of homeless adults and matched controls under a universal health insurance system. METHODS: We assessed health care utilization by 1165 homeless single men and women and adults in families and their age- and gender-matched low-income controls in Toronto, Ontario, from 2005 to 2009, using repeated-measures general linear models to calculate risk ratios and 95% confidence intervals (CIs). RESULTS: Homeless participants had mean rates of 9.1 ambulatory care encounters (maximum = 141.1), 2.0 emergency department (ED) encounters (maximum = 104.9), 0.2 medical-surgical hospitalizations (maximum = 14.9), and 0.1 psychiatric hospitalizations per person-year (maximum = 4.8). Rate ratios for homeless participants compared with matched controls were 1.76 (95% CI = 1.58, 1.96) for ambulatory care encounters, 8.48 (95% CI = 6.72, 10.70) for ED encounters, 4.22 (95% CI = 2.99, 5.94) for medical-surgical hospitalizations, and 9.27 (95% CI = 4.42, 19.43) for psychiatric hospitalizations. CONCLUSIONS: In a universal health insurance system, homeless people had substantially higher rates of ED and hospital use than general population controls; these rates were largely driven by a subset of homeless persons with extremely high-intensity usage of health services.
Authors: Stephen W Hwang; Joanna J M Ueng; Shirley Chiu; Alex Kiss; George Tolomiczenko; Laura Cowan; Wendy Levinson; Donald A Redelmeier Journal: Am J Public Health Date: 2010-06-17 Impact factor: 9.308
Authors: Stephen W Hwang; Angela Colantonio; Shirley Chiu; George Tolomiczenko; Alex Kiss; Laura Cowan; Donald A Redelmeier; Wendy Levinson Journal: CMAJ Date: 2008-10-07 Impact factor: 8.262
Authors: William G Honer; Alejandro Cervantes-Larios; Andrea A Jones; Fidel Vila-Rodriguez; Julio S Montaner; Howard Tran; Jimmy Nham; William J Panenka; Donna J Lang; Allen E Thornton; Talia Vertinsky; Alasdair M Barr; Ric M Procyshyn; Geoffrey N Smith; Tari Buchanan; Mel Krajden; Michael Krausz; G William MacEwan; Kristina M Gicas; Olga Leonova; Verena Langheimer; Alexander Rauscher; Krista Schultz Journal: Can J Psychiatry Date: 2017-02-15 Impact factor: 4.356
Authors: Richard E Nelson; Ying Suo; Warren Pettey; Megan Vanneman; Ann Elizabeth Montgomery; Thomas Byrne; Jamison D Fargo; Adi V Gundlapalli Journal: Health Serv Res Date: 2018-09-23 Impact factor: 3.402
Authors: Katherine A Koh; Melanie Racine; Jessie M Gaeta; John Goldie; Daniel P Martin; Barry Bock; Mary Takach; James J O'Connell; Zirui Song Journal: Health Aff (Millwood) Date: 2020-02 Impact factor: 6.301
Authors: Anne M Gadermann; Mohammad Ehsanul Karim; Monica Norena; Scott D Emerson; Anita M Hubley; Lara B Russell; Rosane Nisenbaum; Stephen W Hwang; Tim Aubry; Anita Palepu Journal: J Urban Health Date: 2020-04 Impact factor: 3.671
Authors: Denise Jaworsky; Anne Gadermann; Arnaud Duhoux; Trudy E Naismith; Monica Norena; Matthew J To; Stephen W Hwang; Anita Palepu Journal: J Urban Health Date: 2016-08 Impact factor: 3.671