The Experience of Readmission After Trauma Among the Unhoused

Importance Unhoused individuals face significant structural barriers to postacute recovery following traumatic injury. However, national estimates of trauma readmission risk in this population remain limited. This study aimed to evaluate the association between unhoused status and 30-day hospital readmission after trauma. Objective To assess if unhoused status is linked to higher 30-day readmission rates after traumatic injury. Design, Setting, and Participants This retrospective cohort study used data from the 2017 through 2019 National Readmission Database. These data included a national, population-based sample of hospitalizations in the US. Participants included adults aged 18 years or older who were admitted for traumatic injury, identified using International Statistical Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) diagnosis codes. Elective admissions, in-hospital deaths, and discharges in December were excluded, given the 30-day outcome. Unhoused status was defined using ICD-10-CM code Z59.0. A total of 2 663 876 trauma admissions were included, of whom 46 381 were unhoused (1.7%). Patients were stratified by housing status based on the ICD-10 code for homelessness. The primary outcome was 30-day all-cause readmission. Multivariable logistic regression and marginal effects models estimated adjusted odds ratios (aOR) and predicted probabilities, controlling for demographic and clinical factors. Results Unhoused patients were substantially younger (65 years, 10.4% vs 59.4%), predominantly male (77.8% vs 48.2% female), and had much higher rates of substance use disorders (alcohol, 41.3% vs 9.9%; drug, 38.4% vs 5.1%) compared with housed patients; all comparisons were statistically significant ( P lt; .001). The 30-day readmission rate was significantly higher among unhoused patients (19.3% vs 12.2%; P lt; .001), with increased adjusted odds of readmission on multivariable analysis (aOR, 1.63; 95% CI, 1.58-1.67). Against medical advice discharge carried the highest readmission risk among unhoused patients (predicted probability, 30.3%; aOR, 1.81; 95% CI, 1.67-1.96). Unhoused patients were more likely to be readmitted for new traumatic injuries (aOR, 1.48; 95% CI, 1.41-1.56), sequelae of prior trauma (aOR, 1.19; 95% CI, 1.02-1.39), and postprocedural complications (aOR, 1.26; 95% CI, 1.12-1.42). Conclusions and Relevance In this observational study, unhoused status was independently associated with significantly higher odds of 30-day readmission following trauma, often for new injury or poor healing. Improved discharge planning, continuity of care, and access to housing and postacute services are needed.