Hungry Homeless People Likely to Be Hospitalized

Homeless people who do not get enough to eat use hospitals and emergency rooms at very high rates, according to a new study. One in four respondents to a nationwide survey reported not getting enough to eat, a proportion six times higher than in the general population, and more than two thirds of those had recently gone without eating for a whole day, according to a study published in the Journal of General Internal Medicine.

"The study is the first to highlight the association between food insufficiency and health care use in a national sample of homeless adults," said lead author Travis P. Baggett, MD, MPH, of the Massachusetts General Hospital (MGH) General Medicine Division, in a press release. “Our results suggest a need to better understand and address the social determinants of health and health-care-seeking behavior.”

Baggett and a team of investigators at MGH and the Boston Health Care for the Homeless Program analyzed survey data from 966 adult respondents to the 2003 nationwide Health Care for the Homeless User Survey. Using multivariable logistic regression, they examined the association between food insufficiency and four acute health services utilization outcomes: hospitalization for any reason, psychiatric hospitalization, any ED use, and high ED use (≥4 visits).

The investigators found that homeless people who did not have enough to eat had a higher risk of being hospitalized in a medical or psychiatric unit than did those with enough to eat and also were more likely to be frequent users of emergency rooms. Neither relationship could be explained by individual differences in illness. Nearly half of the hungry homeless had been hospitalized in the preceding year and close to one-third had used an emergency room four or more times in the same year.

“Addressing the adverse health services utilization patterns of homeless adults will require attention to the social circumstances that may contribute to this issue,” the authors wrote.

According to Baggett, who is instructor in Medicine at Harvard Medical School, the study was sparked by his clinical experience caring for homeless individuals. “Homeless patients with inadequate food may have difficulty managing their health conditions or taking their medications,” he said. “They may postpone routine health care until the need is urgent and may even use emergency rooms as a source of food. Whether expanding food services for the very poor would ameliorate this problem is uncertain, but it begs further study.”