Year: 2021 Source: American Journal of Epidemiology. (2021). Published on line 12 February 2021. doi: 10.1093/aje/kwab037 SIEC No: 20210202

Suicide remains the leading cause of death among homeless youth. We assessed differences in healthcare utilization between homeless and non-homeless youth presenting to the emergency department or hospital after a suicide attempt. New York Statewide Inpatient and Emergency Department Databases (2009-2014) were used to identify homeless and non-homeless youth ages 10 to 17 who utilized healthcare services following a suicide attempt. To evaluate associations with homelessness, we used logistic regression models for mortality, use of violent means, intensive care unit utilization, log-transformed linear regression models for hospitalization cost, and negative binomial regression models for length of stay. All models were adjusted by individual characteristics with a hospital random effect and year fixed effect. We identified 18,026 suicide attempts with healthcare utilization rates of 347.2 (95% Confidence Interval [CI]: 317.5, 377.0) and 67.3 (95%CI: 66.3, 68.3) per 100,000 person-years for homeless and non-homeless youth, respectively. Length of stay for homeless youth was statistically longer than non-homeless youth (Incidence Rate Ratio 1.53; 95%CI: 1.32, 1.77). All homeless youth who visited the emergency department after a suicide attempt were subsequently hospitalized. This could suggest a higher acuity upon presentation among homeless youth compared with non-homeless youth. Interventions tailored to homeless youth should be developed.