Housing Status and Healthcare Utilization in People Presenting with Seizures
Sandeepa Mullady1, Andrew Wood2, Elan Guterman3, Nicole Rosendale4
1Stanford University, 2Department of Neurology, University of California San Francisco, 3University of California, San Francisco, 4UCSF Dept of Neurology at ZSFG
Objective:
To examine the association between housing status and healthcare utilization (length of stay, discharge disposition, 30-day re-visit) in individuals presenting to the hospital with a seizure.
Background:
Prior research suggests seizures commonly lead to hospitalization for people experiencing homelessness (PEH); however, little is known about the healthcare utilization in this population.
Design/Methods:
We performed a retrospective cross-sectional analysis of all patients presenting to the emergency room at a San Francisco County hospital between 1/1/2016-8/03/2019 with a primary diagnosis of seizure based on ICD-9 and 10 codes. We examined differences in comorbidities, demographics, and severity of presentation between housed individuals and PEH. To evaluate the association between housing status and utilization, we performed a multivariable linear regression for length of stay and multivariable logistic regression for discharge disposition (self-care vs. another facility) and 30-day re-visit adjusting for age, comorbidities, and insurance status.
Results:
The sample included 6483 individuals (2092 [32.3%] PEH). Compared to those housed, PEH were younger (48.2 years, p<0.0001), male (82.2%, p<0.0001), and had Medicaid (74.4%, p=0.0002). People with housing had higher prevalence of admission to the intensive care unit (3.6%, p<0.0001). In the fully adjusted model, PEH who were admitted to the hospital after seizure had higher odds of 30-day revisit (adjusted odds ratio [aOR] 1.87, 95% confidence interval [CI] 1.58, 2.21), shorter length of stay (coef B-12.87, 95% CI -22.62, -3.11), and lower odds of being discharged to a facility (aOR 0.37, 95% CI 0.26, 0.55) compared to those housed.
Conclusions:
PEH with seizures had increased healthcare utilization with more 30-day re-visits, but paradoxically had lower lengths of stays and discharges to facilities. Further analysis including imaging findings, anti-seizure medications prescribed, and presumed etiology is needed to create a more nuanced understanding of healthcare utilization among PEH.