Inflammatory bowel disease outcomes among hospitalized homeless individuals

BACKGROUND: There is a paucity of outcome data among homeless individuals with inflammatory bowel diseases (IBD). We reported rates of homelessness among inpatients with Crohn's disease (CD) and ulcerative colitis (UC) and examined inpatient outcomes. METHODS: The Healthcare Utilization Project (HCUP) State Inpatient Databases from New York, Arizona, Massachusetts and Florida for 2013 and 2014 were used to identify adults ≥ 18 years admitted with IBD identified by ICD-9 codes. Homeless patients were propensity score matched using a one-to-ten greedy nearest-neighbor approach to non-homeless patients to balance the distribution of baseline covariates. Differences in mortality, endoscopy utilization, surgical treatment and post-operative complications were reported as odds ratios with 95% confidence intervals (CI). RESULTS: A total of 115,008 IBD hospitalizations were identified of which 61% (n = 70,457) were CD discharges while 39% (n = 44,551) were UC discharges. Homelessness was associated with 0.7% (n = 469) of CD discharges and 0.9% (n = 415) of UC discharges. Mortality and endoscopy utilization rates were comparable between homeless and non-homeless patients with CD and UC. Surgical treatment was also broadly similar except for lower odds of bowel resection among homeless IBD patients with UC compared to domiciled IBD patients with UC (OR: 0.41, 95% CI: 0.20 to 0.84). Post-operative complications were also comparable except for lower rates of venous thromboembolism among homeless patients with CD (OR: 0.61, 95% CI: 0.38 to 0.97) whereas it was higher for homeless patients with UC (OR: 1.58, 95% CI: 1.08 to 2.30). CONCLUSIONS: Homeless IBD patients have comparable inpatient outcomes with non-homeless IBD patients.