Increasing trends of hospital admissions for unhoused patients in the United States

This serial cross-sectional study assessed the nationwide prevalence and temporal trends of hospitalization for patients with unhoused status in the United States. The Agency for Healthcare Research and Quality’s Healthcare Cost and Utilization Project National Inpatient Sample was queried and included 241,001,774 hospital admissions for any indication from 2016 to 2022. Unhoused status, identified according to the National Health Care for the Homeless Council recommendation schema, was reported in 2,818,983 (1.2%) hospital admissions. Over the 7-year study period, the prevalence rate of hospitalizations for patients experiencing houselessness increased by 68.6% from 0.9% to 1.4% from 2016 to 2022 (average annual percentage change 8.7, 95% confidence interval 7.2 to 10.6). Hospital occupation rate by patients with unhoused status also increased from 1.4% to 2.1% (average annual percentage change 7.6, 95% confidence interval 4.6 to 11.2). Among the patients with unhoused status, the majority were male (71.7%) compared to female (28.3%). The majority of patients with unhoused status were White (54.9%), followed by Black (24.4%), and Hispanic (11.7%). The increasing rate of hospitalization with houselessness status was largest in Hispanic, followed by Native American, Black, Asian, and White. When assessed by U.S. census region, the Pacific division had a higher prevalence rate of hospital admissions for patients with unhoused status when compared to other divisions (2.2% versus 0.7%-1.5%, standardized mean difference 0.375). The annual increasing rate was highest in the East South Central division, followed by the West South Central and West North Central divisions (all, average annual percentage increase > 10%). In conclusion, this nationwide assessment suggests that the number of hospitalizations for people experiencing houselessness is increasing in the United States with variable differences across the geographic areas.