Triage scores suggest that the health of persons experiencing homelessness has worsened from 2010 to 2017; Time series evidence from population level ED contacts in Ontario

Background: The health of people experiencing homelessness is worse and health utilization patterns are higher relative to the homed population. However, because this population is marginalized, it is difficult to surveil the health of people experiencing homelessness accurately and efficiently.Methods: The emergency department (ED) is often a primary point of contact for people experiencing homelessness to receive health care. We examine the presenting triage acuity as a proxy for health of persons experiencing homelessness over time. We compare these persons to a sample of people who have never been homeless. Results: The average triage scores for visits by people who are homeless, those with homelessness history, and the homed were 2.97, 3.01, and 3.19 respectively. People who have experienced homelessness are two to three times more likely to present with a triage score of 1 or as a resuscitation-level case compared to those who were never homeless. The gap in triage scores between populations have increased over time.Conclusion: Homeless patients are less healthy and have had worsening health issues relative to the non-homeless population. Administrative data collected through the ED can help demonstrate differences and trends in health, stratified by homelessness status, to help inform public health policy