Temporal Trends and In-Hospital Outcomes of Homeless Traumatic Spinal Cord Injury (TSCI) Patients: A Retrospective National Database Study (2010–2020)

Background: People experiencing homelessness (PEH) face significant health disparities, including higher rates of trauma and reduced access to rehabilitation. While traumatic spinal cord injury (TSCI) is a life-altering condition requiring intensive acute and long-term care, national data on in-hospital outcomes for PEH with TSCI remain limited. Objective: To characterize disparities in demographics, injury mechanisms, and in-hospital outcomes among PEH with TSCI using a large national administrative database. Materials and Methods: We conducted a retrospective cohort study of adult (18 yrs or older) TSCI hospitalizations from 2010 to 2020 using the National (Nationwide) Readmissions Database (NRD). Homelessness was identified using ICD-9/ICD-10 codes. Discharges were weighted using Health Care Cost and Utilization Project’s (HCUP) survey design variables to produce national estimates. We used survey-weighted logistic and linear regressions and propensity score matching (PSM) on available demographic and hospital characteristics to compare homeless and housed patients on in-hospital mortality, length of stay (LOS), total hospital charges, and discharge disposition. Results: Of 231,993 survey-weighted TSCI admissions, 1,944 were identified for homelessness. PEH were younger (mean age 48 yrs vs . 53 yrs), predominantly male (87% vs . 70%), and more likely to have sustained assault-related injuries. After PSM on available covariates, PEH had similar adjusted odds of in-hospital mortality compared with housed patients (aOR: 1.42, 95% CI: 0.58–3.49; P =0.43). However, PEH had significantly longer LOS (mean increase +3.4–6.5 d; P ≤0.002) and higher total hospital charges (mean increase ∼$42,000–$71,000; P <0.001). The odds of an admission being coded as homeless increased steadily over the study period, with an ∼13% annual growth rate (aOR: 1.12, 95% CI: 1.10–1.16; P <0.001). Conclusion: PEH with TSCI have longer, more costly hospitalizations despite similar adjusted in-hospital mortality.