IJPDS International Journal of Population Data Science IJPDS 2399-4908 Swansea University 10.23889/ijpds.v10i3.3084 10:3:69 FARM Household Resilience, Income Source and Earnings (FARM-RISE) Wilson Paul 1 Caskie Paul 2 University of Nottingham, Nottingham, United Kingdom Agri-Food & Biosciences Institute, Belfast, United Kingdom 01 06 2025 2025 8 4 3084 This work is licenced under a Creative Commons Attribution 4.0 International License. This article is available from the IJPDS website at: https://ijpds.org/article/view/3084 Objectives

This study examined the relationship between co-occurring homelessness and substance misuse and the use of secondary healthcare in Wales. The study was carried out as part of the Better Outcomes through Linked Data (BOLD) Substance Misuse Pilot Wales, which focuses on early intervention and prevention of escalation of substance misuse.

 Methods

The study used routinely collected administrative data from the Secure Anonymised Information Linkage (SAIL) Databank. Datasets used include primary care, hospital admissions, emergency department and specialist substance misuse treatment.

We identified a cohort of over 32,000 Welsh residents who were in substance misuse treatment between 2014 and 2019.

The analysis looked at the relationship between co-occurring homelessness and substance misuse in relation to

the frequency of emergency department attendances

the reasons for emergency hospital admissions

the frequency of hospital admissions

the length of hospital admissions

We also looked at how homelessness, types of substance misuse, and demographics interacted.

 Results

For the individuals in substance misuse treatment, homelessness was associated with:

an increase in the number of times an individual would be expected to attend an emergency department

an increased likelihood that an individual would be admitted to hospital as an emergency

an increase in the number of times an individual would be expected to be admitted to hospital

an increased likelihood of emergency hospital admissions for certain diagnoses, including:

injury and poisoning

mental and behavioural disorders

skin diseases

an increase in the expected duration of hospital admissions.

 Conclusion

This study highlights the health impacts of co-occurring homelessness on individuals in substance misuse treatment, showing how people facing multiple disadvantages, like homelessness and substance misuse, experience profound health inequalities.

Understanding how people with these co-occurring conditions access health services could help healthcare providers better plan support for those individuals.