Janet Song, Yu Deng, Yuyang Yang, Lacey Gleason, Abel Kho
Abstract
Housing stability is a key health determinant and there is a need for early screening for instability with existing electronic health record (EHR) data to improve health outcomes. We aim to establish recorded address changes as a screening variable for housing instability and homelessness and to attempt to define the threshold of high churn.
Introduction
Homelessness was estimated to affect 582,462 people in the United States in 2022, disproportionately impacting individuals identifying as Black or African American [1]. Historically, homelessness has been influenced by economic downturns, housing policies, and social safety nets, with significant spikes during periods such as the Great Depression and the post-industrial era [2].
Methods
We utilize a retrospective cross-sectional study design to get a baseline snapshot of address churn using Northwestern Medicine’s (NM) Electronic Data Warehouse (EDW) EHR data including the dates 1/1/2018-1/1/2024.
Results
We observed significant differences in demographics across levels of address churn. The majority of the study population did not move over three years. Patients with a record of homelessness showed a mean churn of 1.83 (SD 1.34).
Discussion
In our study we find that address churn is significantly associated with having experienced homelessness with increased odds of 1.44 [95% CI 1.42 - 1.47]. Other variables associated with ever experiencing homelessness include self-reported race, with EHR recorded race as Black or African American compared to recorded race of White having the greatest odds ratio of 3.42 (95% CI [3.03 - 3.84]).
Conclusion
In conclusion, our study finds a statistically significant association between address churn and homelessness, which highlights a potential avenue for administrative screening to detect signs of housing instability with variables already routinely captured in EHRs.
Citation: Song J, Deng Y, Yang Y, Gleason L, Kho A (2025) Change in address in electronic health records as an early marker of homelessness. PLoS ONE 20(3): e0318552. https://doi.org/10.1371/journal.pone.0318552
Editor: Asadullah Shaikh, Najran University College of Computer Science and Information Systems, SAUDI ARABIA
Received: June 3, 2024; Accepted: January 19, 2025; Published: March 10, 2025
Copyright: © 2025 Song et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: Data cannot be shared publicly due to legal restrictions as data contain potentially identifying patient information. Data are available from the Northwestern University Northwestern Medicine Enterprise Data Warehouse (NMEDW) (contact via fsm-research@northwestern.edu) for researchers who meet the criteria for access to confidential data.
Funding: The author(s) received no specific funding for this work.
Competing interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests: Dr. Abel Kho is an advisor for Datavant. This does not alter our adherence to PLOS ONE policies on sharing data and materials.
