TY - JOUR
T1 - Clinical and Economic Profile of Homeless Young Adults with Stroke in the United States, 2002-2017
AU - Khan, Safi U.
AU - Yedlapati, Siva H.
AU - Khan, Muhammad Zia
AU - Virani, Salim S.
AU - Blaha, Michael J.
AU - Sharma, Garima
AU - Jordan, John E.
AU - Kash, Bita A.
AU - Vahidy, Farhaan S.
AU - Arshad, Adeel
AU - Mossialos, Elias
AU - Nasir, Khurram
N1 - Publisher Copyright:
© 2022 Elsevier Inc.
PY - 2022/3/26
Y1 - 2022/3/26
N2 - Homelessness is a major social determinant of health. We studied the clinical and economic profile of homeless young adults hospitalized with stroke. We studied the National Inpatient Sample database (2002-2017) to evaluate trends of stroke hospitalization, clinical outcomes, and health expenditure in homeless vs non-homeless young adults (<45 years). We identified 3134 homeless individuals out of 648,944 young adults. Homeless patients were more likely to be men, Black adults and had a higher prevalence of cardiometabolic risk factors and psychiatric disorders than non-homeless adults. Both homeless and non-homeless adults had a similar prevalence of ischemic and hemorrhagic stroke. Between 2002 and 2017, hospitalization rates per million increased for both non-homeless (295.8-416.8) and homeless adults (0.5-3.6) (P ≤ 0.01). Between 2003 and 2017, the decline in in-hospital mortality was limited to non-homeless adults (11%-9%), while it has increased in homeless adults (3%-11%) (P < 0.01). The prevalence of acute myocardial infarction (6.8% vs 3.3%, P < 0.01), and acute kidney injury (13.1% vs 9.4%, P < 0.01) was also higher in homeless vs. non-homeless adults. The length of stay and inflation-adjusted care cost were comparable between both study groups. Finally, a higher proportion of homeless patients left the hospital against medical advice than non-homeless adults. Homeless young stroke patients had significant comorbidities, increased hospitalization rates, and adverse clinical outcomes. Therefore, public health interventions should focus on multidisciplinary care to reduce health care disparities among young homeless adults.
AB - Homelessness is a major social determinant of health. We studied the clinical and economic profile of homeless young adults hospitalized with stroke. We studied the National Inpatient Sample database (2002-2017) to evaluate trends of stroke hospitalization, clinical outcomes, and health expenditure in homeless vs non-homeless young adults (<45 years). We identified 3134 homeless individuals out of 648,944 young adults. Homeless patients were more likely to be men, Black adults and had a higher prevalence of cardiometabolic risk factors and psychiatric disorders than non-homeless adults. Both homeless and non-homeless adults had a similar prevalence of ischemic and hemorrhagic stroke. Between 2002 and 2017, hospitalization rates per million increased for both non-homeless (295.8-416.8) and homeless adults (0.5-3.6) (P ≤ 0.01). Between 2003 and 2017, the decline in in-hospital mortality was limited to non-homeless adults (11%-9%), while it has increased in homeless adults (3%-11%) (P < 0.01). The prevalence of acute myocardial infarction (6.8% vs 3.3%, P < 0.01), and acute kidney injury (13.1% vs 9.4%, P < 0.01) was also higher in homeless vs. non-homeless adults. The length of stay and inflation-adjusted care cost were comparable between both study groups. Finally, a higher proportion of homeless patients left the hospital against medical advice than non-homeless adults. Homeless young stroke patients had significant comorbidities, increased hospitalization rates, and adverse clinical outcomes. Therefore, public health interventions should focus on multidisciplinary care to reduce health care disparities among young homeless adults.
UR - http://www.scopus.com/inward/record.url?scp=85130050169&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85130050169&partnerID=8YFLogxK
U2 - 10.1016/j.cpcardiol.2022.101190
DO - 10.1016/j.cpcardiol.2022.101190
M3 - Review article
C2 - 35346726
AN - SCOPUS:85130050169
SN - 0146-2806
VL - 48
JO - Current Problems in Cardiology
JF - Current Problems in Cardiology
IS - 8
M1 - 101190
ER -