Objective: To describe longitudinal changes in homelessness factors associated with more frequent emergency department (ED) use.
Methods: Secondary analysis of responses to triennial Minnesota Statewide Homeless Surveys from 1991–2006. The study used optimized convenience samples of the state’s homeless population through 250 sites and roving interviewers. Participants were asked about demographics, shelter type, access to services, chronic illness, and ED use. Descriptive and bivariate analyses were used to determine associations.
Results: Between 1580 and 3733 homeless individuals have been enrolled every three years since 1991. ED use decreased from 37.1% in 1991 to 32.3% in 1994 and has been increasing to 49.8% in 2006. The association of chronic illness with ED use (OR, 95% CI) increased from 1991 to 1994 (2.07, 1.72–2.50; 3.31 2.65–4.13), decreased in 1997 (1.54, 1.36–1.73), and has been increasing since (2006: 2.22, 1.98–2.50). Association between mental illness and ED use decreased from1991 to 1997 (2.38,1.97–2.88; 1.88, 1.61 to 2.20) and has been increasing since (2006: 2.18, 1.94–2.46). The association between substance abuse and ED use has been decreasing since 1991 (2.06, 1.75–2.41; 2006: 1.58, 1.37–1.83). The association between medical assistance and ED use has been increasing since 1991 (2.14, 1.76–2.61;2006: 2.43, 2.08–2.83). Loss of services had no association with ED use in 1991, but has had a continued association since 1997 (1.52, 1.29–1.81; 2006: 1.40, 1.20–1.64). Compared with other shelter types, transitional housing has become less associated with ED use (1991: 1.53,1.01–2.34 to no association), while unsheltered and battered women’s shelter status have become more asso-ciated (2006: 1.30, 1.11–1.53).
Conclusions: Among the homeless, associations between ED use and chronic illness, medical assistance, loss of services and certain shelter types have increased, while associations with substance abuse andtransitional housing have decreased.