Health Care Utilization Among People Experiencing Homelessness in a Rural Region.

Little is known about health care utilization among people experiencing homelessness (PEH) in rural areas, who are often unsheltered and face barriers from geographic isolation and resource shortages. We examined emergency department (ED) and acute hospitalization utilization in relation to weather patterns among PEH at a rural health care system in Northwest Michigan (2018-2022). Mental and behavioral health diagnoses accounted for 66.3% of ED visits and 84.4% of hospitalizations. Higher maximum daily temperature was associated with increased ED visits (β=0.017, 95% CI=0.01, 0.24), while total precipitation was associated with fewer visits (β=-0.053, 95% CI=-0.087, -0.021). Greater cumulative snow depth was linked to increased ED visits (β=0.022, 95% CI=0.008, 0.036) and hospitalizations (β=0.034, 95% CI=0.002, 0.065). Shelter availability was associated with lower monthly hospitalization rates (mean difference=-1.42, 95% CI=-2.46, -0.39). These findings underscore the need for targeted mental health services and weather-responsive care strategies for PEH in rural areas.