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May 2002, Vol 92, No. 5 | American Journal of Public Health 778-784
© 2002 American Public Health Association

RESEARCH AND PRACTICE

Emergency Department Use Among the Homeless and Marginally Housed: Results From a Community-Based Study

Margot B. Kushel, MD, Sharon Perry, PhD, David Bangsberg, MD, MPH, Richard Clark, MPH and Andrew R Moss, PhD

Margot B. Kushel is with the Division of General Internal Medicine, University of California at San Francisco/San Francisco General Hospital, San Francisco, Calif. Sharon Perry, David Bangsberg, Richard Clark, and Andrew R. Moss are with the Department of Epidemiology and Biostatistics, University of California at San Francisco. David Bangsberg is also with the Division of Infectious Diseases, Department of Medicine, University of California at San Francisco/San Francisco General Hospital.

Correspondence: Requests for reprints should be sent to Margot B. Kushel, MD, Division of General Internal Medicine, UCSF/San Francisco General Hospital, Box 1364, San Francisco, CA 94143 (e-mail: kushel{at}itsa.ucsf.edu).

Objectives. This study examined factors associated with emergency department use among homeless and marginally housed persons.

Methods. Interviews were conducted with 2578 homeless and marginally housed persons, and factors associated with different patterns of emergency department use were assessed in multivariate models.

Results. Findings showed that 40.4% of respondents had 1 or more emergency department encounters in the previous year; 7.9% exhibited high rates of use (more than 3 visits) and accounted for 54.5% of all visits. Factors associated with high use rates included less stable housing, victimization, arrests, physical and mental illness, and substance abuse. Predisposing and need factors appeared to drive emergency department use.

Conclusions. Efforts to reduce emergency department use among the homeless should be targeted toward addressing underlying risk factors among those exhibiting high rates of use.




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