Inpatient Hospitalizations and Emergency Department Visits for Patients Experiencing Homelessness in California: Patient Demographics

In 2019, patients experiencing homelessness accounted for 119,815 Inpatient (IP) Hospitalizations and 324,823 Emergency Department (ED) Visits, which is 3.1 percent of all IP hospitalizations (3,827,200) and 2.5 percent of all ED visits (12,847,310).

The visualizations below present patient demographic (age, race/ethnicity, sex, and expected payer) information on IP hospitalizations and ED visits for “Homeless” and “All” patients treated in California hospitals. 

Comparisons between these two groups illustrate where “Homeless” patients are represented disproportionately higher or lower than “All” patients, which may be used to identify important disparities between them.

Key Findings

  • Age: Around 80 percent of IP hospitalizations and ED visits for “Homeless” patients are between the ages of 19 to 59, with the majority falling in the “40 to 59” age group. This is disproportionately higher than “All” patients, where those between 19 to 59 only represent 42 percent of IP hospitalizations and 55 percent of ED visits.
  • Race/Ethnicity: The proportion of encounters for Black or American Indian/Alaska Native “Homeless” patients is double the proportion seen in the “All” group for those races.  IP hospitalizations and ED visits for Hispanic or Asian/Pacific Islander “Homeless” patients are represented at a much smaller proportion than seen in the “All” group.
  • Sex: Males comprise over 70 percent of IP hospitalizations and ED visits for “Homeless” patients, compared to 45 percent in “All” IP hospitalizations and ED visits.
  • Expected Payer: Two-thirds of hospitalizations and ED visits for “Homeless” patients are expected to be covered by Medi-Cal, which is double the proportion of Medi-Cal coverage in “All” IP hospitalizations and around 1.5 times the proportion in “All” ED visits.

Age

  • The “40 to 59” age group comprises around 45 percent of IP hospitalizations and ED visits for “Homeless” patients, compared to 19 percent of “All” IP hospitalizations and 24 percent of “All” ED visits.
  • For the “19 to 39” age group, “Homeless” patients experienced IP hospitalizations and ED visits at a higher proportion than the “19 to 39” age group for “All” IP hospitalizations and ED visits.
  • Together, those two age groups, “19 to 39” and “40 to 59”, account for approximately 80 percent of all “Homeless” IP hospitalizations and ED visits, compared to only 42 percent of “All” IP hospitalizations and 55 percent of “All” ED visits.
  • The proportion of “0 to 18” and “60+” hospitalizations and ED visits for “Homeless” patients is noticeably less than the proportions seen in “All” IP hospitalizations and ED visits.

Note: Unknown age is not included

Race/Ethnicity

  • The proportion of IP hospitalizations and ED visits for Black “Homeless” patients is over twice as large as for “All” Black patients.
  • The proportion of IP hospitalizations and ED visits for Hispanic and Asian/Pacific Islander “Homeless” patients is disproportionately lower than Hispanic and Asian/Pacific Islander for “All” patients.
  • The proportion of IP hospitalizations and ED visits for White “Homeless” patients is slightly higher than “All” White patients, with the difference being more pronounced for ED visits.
  • As the smallest race/ethnicity group, the proportion of IP hospitalizations and ED visits for American Indian/Alaska Native “Homeless” patients is around double that of “All” IP hospitalizations and ED visits.

Note: Other Race/Ethnicity includes Multi-Racial, Other, Unknown, Invalid, and Missing

Sex

  • Males comprise a disproportionately high share (over 70 percent) of the IP hospitalizations and ED visits for “Homeless” patients, compared to 45 percent of “All” IP hospitalizations and ED visits.
  • Females account for close to 30 percent of the IP hospitalizations and ED visits for “Homeless” patients, but around 55 percent of “All” IP hospitalizations and ED visits.

Note: Unknown sex is not included

Expected Payer

  • Medi-Cal is the most common expected primary payer for “Homeless” patients, providing coverage for almost two-thirds of IP hospitalizations and ED visits.
  • The proportion of IP hospitalizations covered by Medi-Cal for “Homeless” patients  is double the proportion for “All” patients. For ED visits, Medi-Cal covers almost 1.5 times the proportion of visits for “Homeless” patients than for “All”.
  • In contrast, Medicare and Private Coverage provide disproportionately less coverage for “Homeless” patients compared to “All” patients.
  • For both IP hospitalizations and ED visits, the proportion of Uninsured “Homeless” patients is approximately double the proportion of Uninsured “All” patients.

Note: Other Payer includes Workers’ Compensation, Other Government, Title V, Disability, VA Plan, Other Payer, Invalid, and Missing

Additional Information

  • “Homeless” encounters are identified by a diagnosis code of “Z59.0” (homelessness) in any diagnosis position and/or Patient ZIP Code of “ZZZZZ” (homeless).
  • The 2019 data provides the most complete data to date needed to analyze “Homeless” encounters for patients who are “Homeless.” The identification of “Homeless” in the data has significantly improved over the past few years because of:
    • A focused outreach by OSHPD to educate facilities about inconsistencies/errors in reporting, including the addition of edit flags to address such inconsistencies.
    • National coding changes to expand the reporting of “Homelessness “based on information documented by all clinicians involved in the care of the patient.” https://www.aha.org/system/files/2018-04/value-initiative-icd-10-code-social-determinants-of-health.pdf
    • The collection of ZIP Code “ZZZZZ” specific to “Homeless” in the ED data, beginning in 2019.

Topic: Healthcare Utilization
Temporal Coverage: 2019
Spatial/Geographic Coverage: Statewide
Frequency: Annual
Source Link: Healthcare Quality
Citation: Office of Statewide Health Planning and Development: Healthcare Quality