P3.160: Increased Hospital Readmission Rates Amongst Children and Youth with Housing Instability

Background:

Background: Housing instability is prevalent among families and even more frequent among young adults. Children with housing instability have worse healthcare outcomes, including higher rates of “poor” health, developmental delay, obesity, malnutrition, dental and visual problems, depression, and suicide. However, the effect of pediatric housing instability on hospital utilization has not been well-characterized. Readmissions can reflect quality of care during an inpatient hospitalization, particularly for vulnerable populations where transitions from inpatient to ambulatory care are high-risk periods. The association between readmissions and housing instability has only been assessed in two specific disease subsets in pediatric populations– asthma and diabetes, where patients experiencing homelessness were more likely to be readmitted within a year. A broader understanding of the relationship between pediatric housing instability and readmission is needed. The objective of this study is to determine whether pediatric housing instability is associated with hospital 30- and 7- day readmission rates.

Methods:

Methods: This was a retrospective cohort study using the Healthcare Cost and Utilization Project 2022 National Readmissions Database. We included all hospital admission encounters for patients under 22 years old. We excluded birth encounters, elective admissions, discharge after November 30, and admissions ending in death. The primary exposure was housing instability as identified by ICD-10 codes: Z59.0 for homelessness, Z59.81 for housing instability, and Z59.1 for inadequate housing. The primary outcome was 30-day readmission rate. Secondary outcomes included 7-day readmission rates, length of stay, and total charges. Additional covariates included age, sex, insurance status, and median neighborhood income. We used multivariate logistic regression to examine the association between housing instability and our primary and secondary outcomes. Stratified analyses were performed to examine the association between housing instability and readmission by patient age group.

Results:

Results: Of 599,637 index admissions, 6,611 (1.1%) included an ICD-10 code for housing instability. Patients with housing instability were more likely to be older, male, have public insurance, and live in a neighborhood with the lowest quartile median income (Table 1). Thirty-day readmission rates for those with housing instability were 16% as compared to 9% for those without (adjusted OR: 1.8, 95% CI: 1.6-2.0). Seven-day readmission rates were 7% for those with housing instability as compared to 3% for those without (adjusted OR: 2.0, 95% CI: 1.7-2.3) (Table 2). Stratified analyses demonstrated that patients with housing instability who were less than one year of age or aged 18-22 years had the highest odds of 7-and 30-day readmissions. Patients with housing instability had longer lengths of stay but less total charges.

Conclusion:

Conclusion: Children and young adults with housing instability are at higher risk for 7-day and 30-day readmissions as well as longer hospitalizations, highlighting the need for improved interventions to optimize care coordination and discharge planning for this vulnerable population.