Objective:

Background:

Young adults experiencing homelessness face unique challenges that exacerbate chronic disease and limit access to consistent care. Few studies have evaluated how homelessness specifically influences outcomes and risk factor patterns in young stroke patients, a group at high risk for long-term disability.

Design/Methods:

We retrospectively analyzed patients aged 18–49 admitted with stroke to a large urban safety-net hospital (2013–25). Homelessness was determined through medical record. Primary outcomes were in-hospital mortality, length of stay (LOS), and discharge modified Rankin Scale (mRS). Secondary analyses examined presentation timing and risk factor interactions. Group differences were assessed using chi-square and t-tests. Multivariable regression models adjusted for age and sex examined associations between homelessness and outcomes, with interaction odds ratio assessed for risk factors (α = 0.05).

Results:

Of 791 patients, 13 (1.6%) were homeless. Homeless patients had higher mortality (23.1% vs 6.9%, p = 0.0257) and longer LOS (37.5 vs 12.2 days, p < 0.0001). After adjustment for age and sex, homelessness remained independently associated with increased mortality (adjusted OR = 5.08, 95% CI 1.93–13.35, p = 0.001) and prolonged LOS (F = 6.27, p = 0.0003), corresponding to 2.8-fold longer hospitalizations. Homeless patients presented earlier (3.4 vs 34.5 hours, p = 0.025) with more arrivals within 4.5 hours (69.2% vs 31.5%, p = 0.0097). Dyslipidemia (interaction OR = 3.77, 95% CI: 1.61–8.84, p = 0.002) showed stronger harmful effects in the homeless population. Homeless patients also trended toward higher mRS 4–6 at discharge (38.5% vs 19.0%, p = 0.160).

Conclusions:

Homelessness was associated with significantly higher mortality and prolonged hospitalization after early-onset stroke, despite faster presentations. These findings highlight the intersection of social instability and health outcomes, though limited by small sample size and potential housing misclassification.