Ayae Yamamoto1, Jack Needleman2, Lillian Gelberg3, Gerald Kominski2, Steven Shoptaw4, Yusuke Tsugawa5. 1. Department of Health Policy and Management, UCLA Fielding School of Public Health, 650 Charles Young Drive South, 31-269 CHS, Los Angeles, CA, 90095, USA. Electronic address: ayaey5@gmail.com. 2. Department of Health Policy and Management, UCLA Fielding School of Public Health, 650 Charles Young Drive South, 31-269 CHS, Los Angeles, CA, 90095, USA; UCLA Center for Health Policy Research, 10960 Wilshire Blvd, Suite 1550, Los Angeles, CA, 90024, USA. 3. Department of Health Policy and Management, UCLA Fielding School of Public Health, 650 Charles Young Drive South, 31-269 CHS, Los Angeles, CA, 90095, USA; Department of Family Medicine, David Geffen School of Medicine at UCLA, 10880 Wilshire Blvd, Suite 1800, Los Angeles, CA, 90024, USA. 4. Department of Family Medicine, David Geffen School of Medicine at UCLA, 10880 Wilshire Blvd, Suite 1800, Los Angeles, CA, 90024, USA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, 760 Westwood Plaza, Los Angeles, CA, 90095, USA. 5. Department of Health Policy and Management, UCLA Fielding School of Public Health, 650 Charles Young Drive South, 31-269 CHS, Los Angeles, CA, 90095, USA; UCLA Center for Health Policy Research, 10960 Wilshire Blvd, Suite 1550, Los Angeles, CA, 90024, USA; Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, 1100 Glendon Avenue, Los Angeles, CA, 90024, USA.
Abstract
BACKGROUND: Although homelessness and opioid overdose are major public health issues in the U.S., evidence is limited as to whether homelessness is associated with an increased risk of opioid overdose. OBJECTIVE: To compare opioid-related outcomes between homeless versus housed individuals in low-income communities. DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional analysis of individuals who had at least one ED visit or hospitalization in four states (Florida, Maryland, Massachusetts, and New York) in 2014. MEASUREMENTS: Risk of opioid overdose and opioid-related ED visits/hospital admissions were compared between homeless versus low-income housed individuals, adjusting for patient characteristics and hospital-specific fixed effects (effectively comparing homeless versus low-income housed individuals treated at the same hospital). We also examined whether risk of opioid-related outcomes varied by patients' sex and race/ethnicity. RESULTS: A total of 96,099 homeless and 2,869,230 low-income housed individuals were analyzed. Homeless individuals had significantly higher risk of opioid overdose (adjusted risk, 1.8% for homeless vs. 0.3% for low-income housed individuals; adjusted risk difference [aRD], +1.5%; 95%CI, +1.0% to +2.0%; p < 0.001) and opioid-related ED visit/hospital admission (10.4% vs. 1.5%; aRD, +8.9%; 95%CI, +7.2% to +10.6%; p < 0.001) compared to low-income housed individuals. Non-Hispanic White females had the highest risk among the homeless population, whereas non-Hispanic White males had the highest risk among the low-income housed population. LIMITATIONS: Individuals with no ED visit or hospitalization in 2014 were not included. CONCLUSION: Homeless individuals had disproportionately higher adjusted risk of opioid-related outcomes compared to low-income housed individuals treated at the same hospital. Among homeless individuals, non-Hispanic White females incurred the highest risk. These findings highlight the importance of recognizing the homeless population-especially the non-Hispanic White female homeless population-as a high-risk population for opioid overdose.
BACKGROUND: Although homelessness and opioid overdose are major public health issues in the U.S., evidence is limited as to whether homelessness is associated with an increased risk of opioid overdose. OBJECTIVE: To compare opioid-related outcomes between homeless versus housed individuals in low-income communities. DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional analysis of individuals who had at least one ED visit or hospitalization in four states (Florida, Maryland, Massachusetts, and New York) in 2014. MEASUREMENTS: Risk of opioid overdose and opioid-related ED visits/hospital admissions were compared between homeless versus low-income housed individuals, adjusting for patient characteristics and hospital-specific fixed effects (effectively comparing homeless versus low-income housed individuals treated at the same hospital). We also examined whether risk of opioid-related outcomes varied by patients' sex and race/ethnicity. RESULTS: A total of 96,099 homeless and 2,869,230 low-income housed individuals were analyzed. Homeless individuals had significantly higher risk of opioid overdose (adjusted risk, 1.8% for homeless vs. 0.3% for low-income housed individuals; adjusted risk difference [aRD], +1.5%; 95%CI, +1.0% to +2.0%; p < 0.001) and opioid-related ED visit/hospital admission (10.4% vs. 1.5%; aRD, +8.9%; 95%CI, +7.2% to +10.6%; p < 0.001) compared to low-income housed individuals. Non-Hispanic White females had the highest risk among the homeless population, whereas non-Hispanic White males had the highest risk among the low-income housed population. LIMITATIONS: Individuals with no ED visit or hospitalization in 2014 were not included. CONCLUSION: Homeless individuals had disproportionately higher adjusted risk of opioid-related outcomes compared to low-income housed individuals treated at the same hospital. Among homeless individuals, non-Hispanic White females incurred the highest risk. These findings highlight the importance of recognizing the homeless population-especially the non-Hispanic White female homeless population-as a high-risk population for opioid overdose.
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