Background and objectives This study examined the associations between homelessness and clinical outcomes of CKD among adults from the urban healthcaresafety net.
Design, setting, participants, & measurementsThis retrospective cohort study examined 15,343 adults with CKD stages3–5 who received ambulatory care during 1996–2005from the Community Health Network of SanFrancisco. Main outcome measures were time to ESRD or death andfrequency of emergencydepartment visits and hospitalizations.
Results Overall, 858persons (6%) with CKD stages 3–5 were homeless. Homeless adults wereyounger, were disproportionately male anduninsured, and suffered from far higher rates ofdepression and substance abuse compared with adults with stable housing(P<0.001 for all comparisons). Over a median follow-up of2.8 years (interquartile range=1.4–6.1), homeless adults experiencedsignificantly higher crude risk of ESRD or death(hazard ratio=1.82, 95% confidence interval=1.49–2.22) compared withhousedadults. This elevated risk was attenuated butremained significantly higher (adjusted hazard ratio=1.28, 95%confidence interval=1.04–1.58)after controlling for differences insociodemographics, comorbid conditions, and laboratory variables.Homeless adults werealso far more likely to use acute care services(median [interquartile range] number of emergency department visits was 9[4–20] versus 1 [0–4], P<0.001) than housed counterparts.
Conclusions Homelessadults with CKD suffer from increased morbidity and mortality and usecostly acute care services far more frequentlythan peers who are stably housed. These findingswarrant additional inquiry into the unmet health needs of the homelesswithCKD to provide appropriate and effective care tothis disadvantaged group.(Authors)