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Objectives. To describe longitudinal health service utilization and expenditures for homeless family members before and after entering an emergency shelter. Methods. We linked Massachusetts emergency housing assistance data with Medicaid claims between July 2008 and June 2015, constructing episodes of health care 12 months before and 12 months after families entered a shelter.We modeled emergency department visits, hospital admissions, and expenditures over the 24-month period separately for children and adults. Results. Emergency department visits, hospital admissions, and expenditures rose steadily before shelter entry and declined gradually afterward, ending, in most cases, near the starting point. Infants, pregnant women, and individuals with depression, anxiety, or substance use disorder had significantly higher rates of all outcomes. Many children’s emergency department visits were potentially preventable. Conclusions. Increased service utilization and expenditures begin months before families become homeless and are potentially preventable with early intervention. Infants are at greater risk. Public Health Implications. Early identification and intervention to prevent homeless episodes, focusing on family members with behavioral health disorders, who are pregnant, or who have young children, may save money and improve family health. [ABSTRACT FROM AUTHOR]

Homeless infants are known to have poor birth outcomes, but the longitudinal impact of homelessness on health, health care use, and health spending during the early years of life has received little attention. Linking Massachusetts emergency shelter enrollment records for the period 2008-15 with Medicaid claims, we compared 5,762 infants who experienced a homeless episode with a group of 5,553 infants matched on sex, race/ethnicity, location, and birth month. Infants bom during a period of unstable housing resulting in homelessness had higher rates of low birthweight, respiratory problems, fever, and other common conditions; longer neonatal intensive care unit stays; more emergency department visits; and higher annual spending. Differences in most health conditions persisted for two to three years. Asthma diagnoses, emergency department visits, and spending were significantly higher through age six. While screening and access to health care can be improved for homeless infants, long-term solutions require a broader focus on housing and income. [ABSTRACT FROM AUTHOR]

The author comments on the study by Clark et al that analyzed the relationship between homelessness and infant health outcomes in the U.S. He raises issue about Clark's use of bivariable analysis considering the limitation of this model. Based on this shortcomings, he shows interest in analyzing the intersection between homelessness and infant health outcomes using multivariable analysis which he believes could improve the current findings.