Excess hospital burden amongst young people in contact with homelessness services in South Australia - a prospective linked data study

Abstract

Purpose: Youth homelessness remains an ongoing public health issue worldwide. We aimed to describe the burden of emergency department (ED) presentations and hospitalizations among a South Australian population of young people in contact with specialist homelessness services (SHS). Methods: This whole-of-population study used de-identified, linked administrative data from the Better Evidence Better Outcomes Linked Data (BEBOLD) platform on all individuals born between 1996 and 1998 (N ¼ 57,509). The Homelessness2Home data collection was used to identify 2,269 young people in contact with SHS at ages 16e17 years. We followed these 57,509 individuals to age 18e19 years and compared ED presentations and hospital separations related to mental health, self-harm, drug and alcohol, injury, oral health, respiratory conditions, diabetes, pregnancy, and potentially preventable hospitalizations between those in contact and not in contact with SHS. Results: Four percent of young people had contact with SHS at ages 16e17 years. Young people who had contact with SHS were 2 and 3 times more likely to have presented to an ED and hospital respectively, compared to those who did not contact SHS. This accounted for 13% of all ED presentations and 16% of all hospitalizations in this age group. Excess burden causes included mental health, self-harm, drug and alcohol, diabetes, and pregnancy. On average, young people in contact with SHS experienced an increased length of stay in ED (þ0.6 hours) and hospital (þ0.7 days) per presentation, and were more likely to not wait for treatment in ED and to self-discharge from hospital. Discussion: The 4% of young people who contacted SHS at ages 16e17 years accounted for 13% and 16% of all ED presentations and hospitalizations respectively at age 18e19 years. Prioritizing access to stable housing and primary health-care services for adolescents in contact with SHS in Australia could improve health outcomes and reduce health-care costs.