Background: Diabetes mellitus (DM) is increasing in prevalence among U.S. children. Disparity across race and socioeconomic status for DM incidence as well as DM outcomes have been reported. Homeless youth live under unique circumstances that may lead to challenges in self-care. We hypothesized that homelessness may be associated with difficulties in blood glucose management, and therefore would lead to increased healthcare utilization. The aim of this study was to assess healthcare utilization related to DM among homeless youth.
Methods: This secondary data analysis identified homeless and non-homeless pediatric patients (<18 years) with a primary diagnosis of DM from the New York statewide inpatient database between 2009 and 2014. Hospitalization rates, readmission rates, hospitalizations with ketoacidosis, admissions through the emergency department (ED), and hospitalization costs and lengths of stay (LOS) were used as outcomes.
Results: We identified 11,202 DM-related hospitalizations, yielding 4.26 and 0.41 hospitalizations per 1,000 homeless and non-homeless children, respectively. Readmissions accounted for 21.0% of homeless and 14.6% of non-homeless hospitalizations (p< .01). Compared with non-homeless patients, homeless patients were more likely to be admitted from ED: Odds Ratio (OR) 1.53, p<.01. Stratified analyses by DM type revealed that homeless patients with DM1 had longer LOS than non-homeless patients: Incidence Rate Ratio (IRR) 1.23, p<.01, whereas a difference in LOS was not detected among patients with DM2. No other outcomes were associated with homelessness.
Conclusions: Homeless youth experience 10.4 times higher DM hospitalization rates than non-homeless youth, with higher rates of readmission. Healthcare utilization was especially high for homeless youth with DM1. Further studies are needed to examine the factors contributing to increased healthcare utilization in order to develop tailored management strategies for homeless youth with diabetes.
R. Sakai-Bizmark: None. J.K. Yee: None.