Health Care Utilization of Homeless Minors With Diabetes in New York State From 2009 to 2014

Objective: This study aims to describe differences in healthcare utilization between homeless and non-homeless minors with diabetes mellitus (DM).

Research Design and Methods: Data from the Healthcare Cost and Utilization Project’s Statewide Inpatient Database from New York for years 2009-2014 was examined to identify pediatric patients <18 years old with DM. Outcomes of interest included: hospitalization rate, in-hospital mortality, admission through the emergency department (ED), diabetic ketoacidosis (DKA), hospitalization cost, and lengths of stay (LOS). Other variables of interest included: age group, race/ethnicity, insurance type, and year. Multivariate logistic regression models were used for in-hospital mortality, admission through ED, and DKA. Log-transformed linear regression models were used for hospitalization cost, and negative binomial regression models were used for LOS.

Results: A total of 643 homeless and 10,559 non-homeless cases were identified. The hospitalization rate was higher among homeless minors, with 3.64 per 1,000 homeless population and 0.38 per 1,000 non-homeless population, respectively. A statistically significant higher readmission rate was detected among homeless minors (20.4% among homeless and 14.1% among non-homeless, p <0.01). Lower rates of DKA (OR 0.75, p=0.02), hospitalization costs (point estimate 0.88, p <.01), and longer LOS (Incidence Rate Ratio (IRR) 1.20, p <0.01) were detected among homeless minors compared to non-homeless minors.

Conclusions: This study found that among minors with DM, those who are homeless experience a higher hospitalization rate than the non-homeless. Housing instability, among other environmental factors, may be targeted for intervention to improve health outcomes.