Understanding the Impact of Homelessness, Substance Use, and Mental Illness on Surgical Outcomes

I recently collaborated with Dr. Tom Warburton on an impactful study titled "The Impact of Homelessness, Substance Use, and Mental Illness on Surgical Inpatient Outcomes in Australia." This research provides critical insights into how these factors influence surgical outcomes and highlights the need for comprehensive health interventions.

Introduction

Homelessness is an ever-growing challenge in Australia, with more than 116,000 individuals experiencing homelessness, including over 8,000 sleeping rough. This vulnerable population often faces a complex interplay of poor health outcomes, mental illness, and substance use disorders (SUD), which can significantly impact their healthcare experiences and outcomes.

Key Findings

Our study analysed retrospective administrative health data from St. Vincent’s Hospital Sydney, covering emergency surgical admissions over five years (2015-2020). Of the 11,229 admissions, 2% were identified as people experiencing homelessness (PEH). The demographic characteristics of PEH included being younger (average age 49 vs. 56 years), predominantly male (77% vs. 61%), and having higher incidences of mental illness (10% vs. 2%) and SUD (54% vs. 10%).

Interestingly, while homelessness itself did not significantly predict surgical complications, it was strongly associated with other poor outcomes:

Discharge Against Medical Advice (DAMA): PEH had 4.3 times greater odds of DAMA than the general population.
Length of Stay (LOS): PEH had a 1.25 times longer LOS.
Risk Factors: Male sex, older age, mental illness, and SUD were significant risk factors for poor surgical outcomes.

Implications

These findings underscore the necessity of addressing physical health alongside mental health and substance use issues for PEH. Effective health interventions must be holistic and multidisciplinary, involving targeted support during and after hospital admissions.

My Contributions

As part of this project, I assisted Dr. Warburton in several key areas:

Understanding the Dataset: We meticulously examined the retrospective data to ensure accurate identification and categorisation of PEH.
Building Explanatory Notebooks: I developed detailed notebooks that explained the statistical methods used, providing clear and accessible insights into our findings.
Creating Visualisations: Visual aids were crucial in illustrating the disparities and risk factors associated with PEH, making the data more understandable for a broader audience.

Conclusion

This study highlights PEH's significant health inequities and the critical need for comprehensive healthcare strategies that address medical and psychosocial factors. By sharing these findings, we hope to contribute to better healthcare policies and practices that improve outcomes for this vulnerable population.

For more detailed insights, you can access the full paper here.