• Kelly M Doran, Martha Shumway, Rani A Hoff, Oni J Blackstock, Samantha E Dilworth, and Elise D Riley.
• Department of Emergency Medicine and Department of Population Health, NYU School of Medicine, Bellevue Hospital Center, New York, New York; U.S. Department of Veterans Affairs. Electronic address: kelly.doran@nyumc.org.
• Womens Health Issues. 2014 Sep 1; 24 (5): 535-41.

PurposeTo examine correlates of emergency department (ED) use and hospitalizations in a community-based cohort of homeless and unstably housed women, with a focus on the role of physical health and pain.MethodsWe conducted a cross-sectional analysis of baseline survey results from a study of homeless and unstably housed women in San Francisco. Primary outcomes were any self-reported ED visit and inpatient hospitalization over the prior 6 months. Primary independent variables of interest were self-reported physical health status, as measured by the Short Form-12 (SF-12), and bodily pain. Other potential covariates were organized using the Gelberg-Andersen Behavioral Model for Vulnerable Populations. Standard bivariate and multivariable logistic regression techniques were used.ResultsThree hundred homeless and unstably housed women were included in the study, of whom 37.7% reported having an ED visit and 23.0% reported being hospitalized in the prior 6 months. Mean SF-12 physical health scores indicated poorer than average health compared with the U.S. norm. Most women (79.3%) reported at least some limitation in their daily activities owing to pain. In adjusted analyses, moderate and high levels of bodily pain were significantly correlated with ED visits (odds ratio [OR], 2.92 and OR, 2.57) and hospitalizations (OR, 6.13 and OR, 2.49). As SF-12 physical health scores decreased, indicating worse health, the odds of ED use increased. Predisposing, enabling, and additional need factors did not mediate these associations.ConclusionsPhysical health and bodily pain are important correlates of ED visits and hospitalizations among homeless and unstably housed women. Interventions to reduce ED use among women who are homeless should address the high levels of pain in this population.Copyright © 2014 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

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