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Substance abuse and psychiatric illness account for the majority of hospital admissions among homeless veterans

Veterans, who make up a disproportionate part of the homeless population, are hospitalized at younger ages than housed veterans. In addition, substance abuse and psychiatric illness account for 80 percent of hospital admissions among homeless veterans, according to a new study. Researchers compared the age at hospital admission and primary discharge diagnoses in a national sample of 43,868 veterans who were hospitalized at 141 Veterans Administration (VA) medical centers between 1996 and 1998. They included only patients in acute medical-surgical beds, acute psychiatric and mental health beds, and acute substance abuse beds.

Homeless veterans admitted for medical or surgical diagnoses were a median of 10-18 years younger than housed veterans, and homeless veterans admitted for psychiatric or substance abuse diagnoses were a median of 3-4 years younger than housed veterans. These findings suggest that homeless veterans have either a more rapid disease course, leading to earlier medical problems, or lower admission thresholds sufficient to prompt hospital admission, note the study authors.

Homeless veterans were also more likely to have been admitted for psychiatric and substance abuse diagnoses than housed veterans (80 vs. 29 percent). Homeless veterans were also more likely to be admitted for diseases such as cellulitis, tuberculosis, and HIV, which are associated with living conditions that are common among homeless people.

The confluence of mental illness, substance abuse, and chaotic social situations render homeless people, including veterans, susceptible to early disease, high hospitalization rates, and premature death. To decrease the early hospitalizations among homeless veterans, policy efforts should focus not only on homeless-specific diseases, but on chronic disease management among homeless patients in the early stages of disease.

The study was supported in part by the Agency for Healthcare Research and Quality (HS11415).

See "Hospitalized younger: A comparison of a national sample of homeless and housed inpatient veterans," by Jennifer Adams, M.D., Robert Rosenheck, M.D., Lauren Gee, J.D., M.P.H., and others, in the February 2007 Journal of Health Care for the Poor and Underserved 18, pp. 173-184.

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