{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T06:46:46Z","timestamp":1793083606897,"version":"4.5.0"},"reference-count":50,"publisher":"American Medical Association (AMA)","issue":"11","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Housing instability and other social determinants of health are increasingly being documented by clinicians. The most common reasons for hospitalization among patients with coded housing instability, however, are not well understood.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To compare the most common reasons for hospitalization among patients with and without coded housing instability.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This cross-sectional, retrospective study identified hospitalizations of patients between age 18 and 99 years using the 2017 to 2019 National Inpatient Sample. Data were analyzed from May to September 2022.<\/jats:p>\n <\/jats:sec>\n \n Exposures<\/jats:title>\n \n Housing instability was operationalized using 5\n International Classification of Diseases, 10th Revision, Social Determinants of Health Z-Codes<\/jats:italic>\n addressing problems related to housing: homelessness; inadequate housing; discord with neighbors, lodgers, and landlords; residential institution problems; and other related problems.\n <\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n The primary outcome of interest was reason for inpatient admission. Bivariate comparisons of patient characteristics, primary diagnoses, length of stay, and hospitalization costs among patients with and without coded housing instability were performed.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Among the 87\u202f348\u202f604 hospitalizations analyzed, the mean (SD) age was 58 (20) years and patients were more likely to be women (50\u202f174\u202f117 [57.4%]) and White (58\u202f763\u202f014 [67.3%]). Housing instability was coded for 945\u202f090 hospitalizations. Hospitalized patients with housing instability, compared with those without instability, were more likely to be men (668\u202f255 patients with coded instability [70.7%] vs 36\u202f506\u202f229 patients without [42.3%];\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001), younger (mean [SD] age 45.5 [14.0] vs 58.4 [20.2] years), Black (235\u202f355 patients [24.9%] vs 12\u202f929\u202f158 patients [15.0%]), Medicaid beneficiaries (521\u202f555 patients [55.2%] vs 15\u202f541\u202f175 patients [18.0%]), uninsured (117\u202f375 patients [12.4%] vs 3\u202f476\u202f841 patients [4.0%]), and discharged against medical advice (28\u202f890 patients [8.4%] vs 451\u202f855 patients [1.6%]). The most common reason for hospitalization among patients with coded housing instability was mental, behavioral, and neurodevelopmental disorders (475\u202f575 patients [50.3%]), which cost a total of $3.5 billion. Other common reasons included injury (69\u202f270 patients [7.3%]) and circulatory system diseases (64\u202f700 patients [6.8%]). Coded housing instability was also significantly associated with longer mean (SD) hospital stays (6.7 [.06] vs 4.8 [.01] days) and a cost of $9.3 billion. Hospitalized patients with housing instability had 18.6 times greater odds of having a primary diagnosis of mental, behavioral, and neurodevelopmental disorders (475\u202f575 patients [50.3%] vs 4\u202f470\u202f675 patients [5.2%]; odds ratio, 18.56; 95% CI, 17.86 to 19.29).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this cross-sectional study, hospitalizations among patients with coded housing instability had higher admission rates for mental, behavioral, and neurodevelopmental disorders, longer stays, and increased costs. Findings suggest that efforts to improve housing instability, mental and behavioral health, and inpatient hospital utilization across multiple sectors may find areas for synergistic collaboration.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2022.41951","type":"journal-article","created":{"date-parts":[[2022,11,14]],"date-time":"2022-11-14T11:04:53Z","timestamp":1668423893000},"page":"e2241951","source":"Crossref","is-referenced-by-count":52,"title":["Association of Coded Housing Instability and Hospitalization in the US"],"prefix":"10.1001","volume":"5","author":[{"given":"Kimberly A.","family":"Rollings","sequence":"first","affiliation":[{"name":"Health and Design Research Fellowship Program, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas","family":"Kunnath","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Michigan, Ann Arbor"},{"name":"Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caitlin R.","family":"Ryus","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander T.","family":"Janke","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut"},{"name":"Veterans Affairs Health Services Research and Development Center for the Study of Healthcare Innovation, Implementation, and Policy\/Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew M.","family":"Ibrahim","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Michigan, Ann Arbor"},{"name":"Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor"},{"name":"Taubman College of Architecture and Urban Planning, University of Michigan, Ann Arbor"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2022,11,14]]},"reference":[{"issue":"3","key":"zoi221183r1","doi-asserted-by":"publisher","first-page":"316","DOI":"10.1089\/pop.2020.0154","article-title":"Prescribing housing: a scoping review of health system efforts to address housing as a social determinant of health.","volume":"24","author":"Koeman","year":"2021","journal-title":"Popul Health Manag"},{"key":"zoi221183r2","doi-asserted-by":"publisher","first-page":"17","DOI":"10.7812\/TPP\/17-079","article-title":"Access to affordable housing promotes health and well-being and reduces hospital visits.","volume":"22","author":"Kottke","year":"2018","journal-title":"Perm J"},{"issue":"4","key":"zoi221183r3","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2021.01547","article-title":"Health-related social needs among older adults enrolled in Medicare Advantage.","volume":"41","author":"Long","year":"2022"},{"issue":"5","key":"zoi221183r5","doi-asserted-by":"publisher","first-page":"404","DOI":"10.1097\/PHH.0000000000001219","article-title":"Permanent supportive housing with housing first to reduce homelessness and promote health among homeless populations with disability: a community guide systematic review.","volume":"26","author":"Peng","year":"2020","journal-title":"J Public Health Manag Pract"},{"issue":"8","key":"zoi221183r6","doi-asserted-by":"publisher","first-page":"964","DOI":"10.1002\/jcop.2014.42.issue-8","article-title":"How stable is stable? Defining and measuring housing stability.","volume":"42","author":"Frederick","year":"2014","journal-title":"J Community Psychol"},{"issue":"2","key":"zoi221183r8","doi-asserted-by":"publisher","first-page":"179","DOI":"10.1007\/s11673-016-9719-z","article-title":"Structural competency in the US healthcare crisis: putting social and policy interventions into clinical practice.","volume":"13","author":"Hansen","year":"2016","journal-title":"J Bioeth Inq"},{"issue":"9","key":"zoi221183r10","doi-asserted-by":"publisher","first-page":"822","DOI":"10.1001\/jama.2018.21476","article-title":"Hospitals turn to housing to help homeless patients.","volume":"321","author":"Kuehn","year":"2019","journal-title":"JAMA"},{"issue":"23","key":"zoi221183r11","doi-asserted-by":"publisher","first-page":"2291","DOI":"10.1001\/jama.2017.15771","article-title":"Investing in housing for health improves both mission and margin.","volume":"318","author":"Sandel","year":"2017","journal-title":"JAMA"},{"issue":"2","key":"zoi221183r12","doi-asserted-by":"publisher","first-page":"200","DOI":"10.1001\/jama.285.2.200","article-title":"Factors associated with the health care utilization of homeless persons.","volume":"285","author":"Kushel","year":"2001","journal-title":"JAMA"},{"issue":"S2","key":"zoi221183r13","doi-asserted-by":"publisher","first-page":"S222","DOI":"10.2105\/AJPH.2020.305693","article-title":"Linking health and housing data to create a sustainable cross-sector partnership.","volume":"110","author":"Laurent","year":"2020","journal-title":"Am J Public Health"},{"issue":"9","key":"zoi221183r14","doi-asserted-by":"publisher","first-page":"1011","DOI":"10.1007\/s11606-016-3680-8","article-title":"Hospital readmissions in a community-based sample of homeless adults: a matched-cohort study.","volume":"31","author":"Saab","year":"2016","journal-title":"J Gen Intern Med"},{"issue":"6","key":"zoi221183r15","doi-asserted-by":"publisher","first-page":"460","DOI":"10.1097\/MLR.0000000000000915","article-title":"Homeless status, postdischarge health care utilization, and readmission after surgery.","volume":"56","author":"Titan","year":"2018","journal-title":"Med Care"},{"issue":"2","key":"zoi221183r16","doi-asserted-by":"publisher","first-page":"1110","DOI":"10.1111\/hesr.2018.53.issue-2","article-title":"Hospital readmission and social risk factors identified from physician notes.","volume":"53","author":"Navathe","year":"2018","journal-title":"Health Serv Res"},{"issue":"5","key":"zoi221183r17","doi-asserted-by":"publisher","DOI":"10.1093\/ofid\/ofz148","article-title":"Housing instability results in increased acute care utilization in an urban HIV clinic cohort.","volume":"6","author":"Clemenzi-Allen","year":"2019","journal-title":"Open Forum Infect Dis"},{"issue":"11","key":"zoi221183r18","doi-asserted-by":"publisher","first-page":"1115","DOI":"10.1037\/\/0003-066X.46.11.1115","article-title":"The epidemiology of alcohol, drug, and mental disorders among homeless persons.","volume":"46","author":"Fischer","year":"1991","journal-title":"Am Psychol"},{"issue":"2","key":"zoi221183r19","doi-asserted-by":"publisher","first-page":"546","DOI":"10.1093\/oxfordjournals.epirev.a036133","article-title":"Risk factors for homelessness.","volume":"15","author":"Susser","year":"1993","journal-title":"Epidemiol Rev"},{"issue":"17","key":"zoi221183r22","doi-asserted-by":"publisher","first-page":"1771","DOI":"10.1001\/jama.2009.561","article-title":"Effect of a housing and case management program on emergency department visits and hospitalizations among chronically ill homeless adults: a randomized trial.","volume":"301","author":"Sadowski","year":"2009","journal-title":"JAMA"},{"issue":"4","key":"zoi221183r23","doi-asserted-by":"publisher","first-page":"505","DOI":"10.1007\/s11524-021-00550-1","article-title":"The effect of a housing first intervention on acute health care utilization among homeless adults with mental illness: long-term outcomes of the At Home\/Chez-Soi Randomized Pragmatic Trial.","volume":"98","author":"Lachaud","year":"2021","journal-title":"J Urban Health"},{"issue":"3","key":"zoi221183r25","doi-asserted-by":"publisher","DOI":"10.2196\/13802","article-title":"Assessing the availability of data on social and behavioral determinants in structured and unstructured electronic health records: a retrospective analysis of a multilevel health care system.","volume":"7","author":"Hatef","year":"2019","journal-title":"JMIR Med Inform"},{"issue":"1","key":"zoi221183r26","doi-asserted-by":"publisher","first-page":"e1","DOI":"10.1016\/j.amepre.2021.01.027","article-title":"Screening discordance and characteristics of patients with housing-related social risks.","volume":"61","author":"De Marchis","year":"2021","journal-title":"Am J Prev Med"},{"issue":"4","key":"zoi221183r27","doi-asserted-by":"publisher","first-page":"584","DOI":"10.1016\/j.amepre.2018.01.020","article-title":"Recent intimate partner violence and housing instability among women veterans.","volume":"54","author":"Montgomery","year":"2018","journal-title":"Am J Prev Med"},{"issue":"4","key":"zoi221183r28","doi-asserted-by":"publisher","first-page":"S117","DOI":"10.1016\/j.annemergmed.2019.08.256","article-title":"298 Characteristics and utilization patterns of homeless and housing-insecure patients presenting to emergency departments across a large health system.","volume":"74","author":"Weleff","year":"2019","journal-title":"Ann Emerg Med"},{"issue":"8","key":"zoi221183r30","doi-asserted-by":"publisher","first-page":"1893","DOI":"10.1002\/jcop.v47.8","article-title":"Unmet mental health and substance use treatment needs among older homeless adults: results from the HOPE HOME Study.","volume":"47","author":"Kaplan","year":"2019","journal-title":"J Community Psychol"},{"issue":"5","key":"zoi221183r31","doi-asserted-by":"publisher","first-page":"197","DOI":"10.1192\/bjb.2020.49","article-title":"Homelessness, housing instability and mental health: making the connections.","volume":"44","author":"Padgett","year":"2020","journal-title":"BJPsych Bull"},{"issue":"16","key":"zoi221183r32","doi-asserted-by":"publisher","first-page":"1657","DOI":"10.1001\/jama.2016.12388","article-title":"Tailoring complex care management for high-need, high-cost patients.","volume":"316","author":"Blumenthal","year":"2016","journal-title":"JAMA"},{"issue":"1","key":"zoi221183r33","doi-asserted-by":"publisher","first-page":"54","DOI":"10.1007\/s11524-016-0110-5","article-title":"Comparing the utilization and cost of health services between veterans experiencing brief and ongoing episodes of housing instability.","volume":"94","author":"Byrne","year":"2017","journal-title":"J Urban Health"},{"issue":"21","key":"zoi221183r34","doi-asserted-by":"publisher","first-page":"2115","DOI":"10.1001\/jama.2019.17432","article-title":"Association of receipt of a housing voucher with subsequent hospital utilization and spending.","volume":"322","author":"Pollack","year":"2019","journal-title":"JAMA"},{"issue":"13","key":"zoi221183r35","doi-asserted-by":"publisher","first-page":"1349","DOI":"10.1001\/jama.2009.414","article-title":"Health care and public service use and costs before and after provision of housing for chronically homeless persons with severe alcohol problems.","volume":"301","author":"Larimer","year":"2009","journal-title":"JAMA"},{"issue":"1","key":"zoi221183r36","doi-asserted-by":"publisher","first-page":"20","DOI":"10.1377\/hlthaff.2015.0393","article-title":"Formerly homeless people had lower overall health care expenditures after moving into supportive housing.","volume":"35","author":"Wright","year":"2016","journal-title":"Health Aff (Millwood)"},{"issue":"10","key":"zoi221183r37","doi-asserted-by":"publisher","first-page":"835","DOI":"10.1136\/jech-2012-202124","article-title":"Economic analysis of the health impacts of housing improvement studies: a systematic review.","volume":"67","author":"Fenwick","year":"2013","journal-title":"J Epidemiol Community Health"},{"issue":"11","key":"zoi221183r38","doi-asserted-by":"publisher","first-page":"475","DOI":"10.1177\/070674371506001103","article-title":"Housing First impact on costs and associated cost offsets: a review of the literature.","volume":"60","author":"Ly","year":"2015","journal-title":"Can J Psychiatry"},{"issue":"25","key":"zoi221183r39","doi-asserted-by":"publisher","first-page":"2374","DOI":"10.1056\/NEJMp1310121","article-title":"Housing as health care\u2014New York\u2019s boundary-crossing experiment.","volume":"369","author":"Doran","year":"2013","journal-title":"N Engl J Med"},{"issue":"12","key":"zoi221183r41","doi-asserted-by":"publisher","first-page":"111","DOI":"10.1007\/s10916-021-01788-7","article-title":"Sensitivity and specificity of real-world social factor screening approaches.","volume":"45","author":"Vest","year":"2021","journal-title":"J Med Syst"},{"issue":"52","key":"zoi221183r42","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000023818","article-title":"International Classification of Diseases, Tenth Revision, Clinical Modification social determinants of health codes are poorly used in electronic health records.","volume":"99","author":"Guo","year":"2020","journal-title":"Medicine (Baltimore)"},{"issue":"12","key":"zoi221183r43","doi-asserted-by":"publisher","first-page":"1037","DOI":"10.1097\/MLR.0000000000001418","article-title":"Utilization of social determinants of health ICD-10 Z-codes among hospitalized patients in the United States, 2016-2017.","volume":"58","author":"Truong","year":"2020","journal-title":"Med Care"},{"issue":"3","key":"zoi221183r44","doi-asserted-by":"publisher","first-page":"952","DOI":"10.1007\/s11606-019-05199-w","article-title":"Use of Z-codes to record social determinants of health among fee-for-service Medicare beneficiaries in 2017.","volume":"35","author":"Weeks","year":"2020","journal-title":"J Gen Intern Med"},{"issue":"1","key":"zoi221183r45","doi-asserted-by":"publisher","first-page":"89","DOI":"10.18865\/ed.31.1.89","article-title":"Homelessness and Medicaid churn.","volume":"31","author":"Dapkins","year":"2021","journal-title":"Ethn Dis"},{"issue":"10","key":"zoi221183r46","doi-asserted-by":"publisher","first-page":"3205","DOI":"10.1007\/s11606-021-06742-4","article-title":"Codifying social determinants of health: a gap in the ICD-10-CM.","volume":"36","author":"Jacobs","year":"2021","journal-title":"J Gen Intern Med"},{"issue":"11","key":"zoi221183r47","doi-asserted-by":"publisher","first-page":"2116","DOI":"10.1377\/hlthaff.2016.0723","article-title":"Integrating social and medical data to improve population health: opportunities and barriers.","volume":"35","author":"Gottlieb","year":"2016","journal-title":"Health Aff (Millwood)"},{"issue":"1","key":"zoi221183r49","doi-asserted-by":"publisher","first-page":"81","DOI":"10.1093\/jamiaopen\/ooy051","article-title":"Documenting social determinants of health-related clinical activities using standardized medical vocabularies.","volume":"2","author":"Arons","year":"2018","journal-title":"JAMIA Open"},{"key":"zoi221183r20","volume-title":"Integrating Social Care Into the Delivery of Health Care: Moving Upstream to Improve the Nation's Health","author":"National Academies of Sciences, Engineering, and Medicine","year":"2019"},{"key":"zoi221183r21","volume-title":"Permanent Supportive Housing: Evaluating the Evidence For Improving Health Outcomes Among People Experiencing Chronic Homelessness","author":"National Academies of Sciences, Engineering, and Medicine","year":"2018"},{"key":"zoi221183r4","unstructured":"Bailey? P. Housing and health partners can work together to close the housing affordability gap. January 17, 2020. Center on Budget and Policy Priorities. Accessed May 16, 2022. https:\/\/www.cbpp.org\/sites\/default\/files\/atoms\/files\/1-17-20hous.pdf"},{"key":"zoi221183r7","unstructured":"Office of Disease Prevention and Health Promotion. Housing instability. Accessed June 6, 2022. https:\/\/www.healthypeople.gov\/2020\/topics-objectives\/topic\/social-determinants-health\/interventions-resources\/housing-instability#7#7"},{"key":"zoi221183r9","unstructured":"Scally? CP, Waxman? E, Gourevitch? R, Adeeyo? S. Emerging strategies for integrating health and housing: innovations to sustain, expand, and replicate. July 2017. Urban Institute. Accessed October 5, 2022. https:\/\/www.urban.org\/sites\/default\/files\/publication\/91941\/emerging_strategies_in_integrating_health_and_housing_final_6.pdf"},{"key":"zoi221183r24","unstructured":"Agency for Healthcare Research and Quality. Healthcare Cost and Utilization Project National Inpatient Sample (NIS). Accessed October 5, 2022. https:\/\/www.hcup-us.ahrq.gov\/nisoverview.jsp"},{"key":"zoi221183r29","unstructured":"Yang? D, Dalton? JE. A unified approach to measuring the effect size between two groups using SAS. 2012. Accessed October 5, 2022. http:\/\/support.sas.com\/resources\/papers\/proceedings12\/335-2012.pdf"},{"key":"zoi221183r40","unstructured":"Centers for Medicare & Medicaid Services. Letter from Anne Marie Costello to state health officials regarding \u201cOpportunities in Medicaid and CHIP to address social determinants of health (SDOH).\u201d January 7, 2021. Accessed October 7, 2022. https:\/\/www.medicaid.gov\/federal-policy-guidance\/downloads\/sho21001"},{"key":"zoi221183r48","unstructured":"Olson? DP, Oldfield? BJ, Morales Navarro? S. Standardizing social determinants of health assessments. Health Affairs Blog. March 18, 2019. Accessed October 5, 2022. https:\/\/www.healthaffairs.org\/do\/10.1377\/hblog20190311"},{"key":"zoi221183r50","doi-asserted-by":"crossref","unstructured":"Billioux? A, Verlander? K, Anthony? S, Alley? D. Standardized screening for health-related social needs in clinical settings: The Accountable Health Communities Screening Tool. National Academy of Medicine; May 30, 2017. Accessed October 5, 2022. https:\/\/nam.edu\/standardized-screening-for-health-related-social-needs-in-clinical-settings-the-accountable-health-communities-screening-tool\/","DOI":"10.31478\/201705b"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2798385\/rollings_2022_oi_221183_1667492183.67595.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,11,14]],"date-time":"2022-11-14T11:04:57Z","timestamp":1668423897000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2798385"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,11,14]]},"references-count":50,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2022,11,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2022.41951","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,11,14]]}}}