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Temporal Trends in Health Service Use

Temporal Trends in Health Service Use and Homelessness

People who are homeless use more hospital-based care than average, yet little is known about how hospital and shelter use are interrelated. We examined the timing of emergency department (ED) visits and hospitalizations relative to entry into and exit from New York City homeless shelters, using an analysis of linked health care and shelter administrative databases.


In the year before shelter entry and the year following shelter exit, 39.3 percent and 43.3 percent, respectively, of first-time adult shelter users had an ED visit or hospitalization. Hospital visits—particularly ED visits—began to increase several months before shelter entry and declined over several months after shelter exit, with spikes in ED visits and hospitalizations in the days immediately before shelter entry and following shelter exit. We recommend cross-system collaborations to better understand and address the co-occurring health and housing needs of vulnerable populations.


Supported by and in collaboration New York University School of Medicine
University of Pennsylvania Social Policy & Practice
NYC Department of Homeless Services

Documents and Links

When Crises Converge: Hospital Visits Before And After Shelter Use Among Homeless New Yorkers
The Wall Street Journal ER Visits Precede First-Time Entry Into New York Homeless Shelters, Study Shows