{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,12]],"date-time":"2026-11-12T22:32:18Z","timestamp":1794522738791,"version":"4.9.1"},"reference-count":43,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2025,10,28]],"date-time":"2025-10-28T00:00:00Z","timestamp":1761609600000},"content-version":"unspecified","delay-in-days":119,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000272","name":"National Institute for Health and Care Research","doi-asserted-by":"publisher","award":["ICA-CDRF-2016-02-042"],"award-info":[{"award-number":["ICA-CDRF-2016-02-042"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["bmjph"],"accepted":{"date-parts":[[2025,9,24]]},"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>People experiencing homelessness have substantial health needs and poor access to primary healthcare, resulting in high rates of hospital care. Housing status is not routinely recorded in English electronic health records, undermining service planning. We developed methods to estimate the scale of hospital admissions for people experiencing homelessness in England.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analysed admissions for people experiencing homelessness using Hospital Episode Statistics for 2013\/2014, 2015\/2016 and 2017\/2018. We applied multiple systems estimation Poisson regression methods to estimate total admissions and an inflation factor to correct for under-reporting. We calculated unadjusted admission rates per 1000 population per year and admission rate ratios compared with the housed population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We observed 34\u2009790 admissions in 2017\/2018, with total homeless admissions estimated at 176 342 (95% CI 164\u2009031 to 188\u2009654) (inflation factor=5.07 (95% CI 4.71 to 5.42)). The unadjusted admission rate for the 2017\/2018 homeless population was 879.0 admissions per 1000 population per year (95%\u2009CI 817.7 to 940.4), 2.5 (95% CI 2.3 to 2.7) times higher than the housed population. Restricted to rough sleepers and hostel residents, the unadjusted rate was 3516.7 per 1000 (95% CI 3271.2 to 3762.2), with a rate ratio of 10.0 (95% CI 9.3 to 10.7) compared with the housed population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>We estimated five times as many hospital admissions for people experiencing homelessness than we observed directly. We advise caution when applying these inflation factors to other datasets because of methodological limitations in this study and sensitivities to local coding practices. In the absence of routine housing status recording, multiple systems estimation could facilitate improved service planning.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjph-2025-002978","type":"journal-article","created":{"date-parts":[[2025,10,29]],"date-time":"2025-10-29T08:01:14Z","timestamp":1761724874000},"page":"e002978","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Estimating the scale of hospital admissions for people experiencing homelessness in England: a population-based multiple systems estimation study using national Hospital Episode Statistics"],"prefix":"10.1136","volume":"3","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6260-4606","authenticated-orcid":false,"given":"Serena April","family":"Luchenski","sequence":"first","affiliation":[{"name":"Institute of Epidemiology and Healthcare, University College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0638-7106","authenticated-orcid":false,"given":"Dankmar","family":"B\u00f6hning","sequence":"additional","affiliation":[{"name":"S3RI & Mathematical Sciences, University of Southampton, Southampton, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0542-0816","authenticated-orcid":false,"given":"Robert","family":"Aldridge","sequence":"additional","affiliation":[{"name":"Institute of Health Informatics, University College London, London, UK"},{"name":"Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2139-2309","authenticated-orcid":false,"given":"Fiona","family":"Stevenson","sequence":"additional","affiliation":[{"name":"Institute of Epidemiology and Healthcare, University College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9802-7727","authenticated-orcid":false,"given":"Shema","family":"Tariq","sequence":"additional","affiliation":[{"name":"Institute of Global Health, University College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3549-6232","authenticated-orcid":false,"given":"Andrew C","family":"Hayward","sequence":"additional","affiliation":[{"name":"Institute of Epidemiology and Healthcare, University College London, London, UK"},{"name":"UK Health Security Agency, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,10,28]]},"reference":[{"key":"2026010703072740000_3.2.e002978.1","unstructured":"ETHOS typology on homelessness and housing exclusion. 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