Impact of Housing Status on Mortality Following Frostbite Injury: A Multicenter Cohort Analysis

Unhoused persons are particularly vulnerable to frostbite injury due to prolonged exposure to extreme temperatures. This study hypothesized that unhoused frostbite injured patients have a higher mortality risk compared to housed individuals. Data from 2 high-volume frostbite centers were analyzed and linked to state health department records. A longitudinal cohort of 933 frostbite patients who survived their initial hospital stay (n = 925) was examined with Cox proportional hazards regression to adjust for confounders (age, sex, race, alcohol use, and drug use). Nearly one-third of patients were unhoused at the time of injury. Most patients discharged home (56.7%), but alternative discharge locations included: [alternative housing (6.1%), inpatient psychiatric care (7.0%), acute rehabilitation (5.7%), nursing care (11.2%), shelter/street (6.4%), and AMA discharge (3.5%)]. During follow-up, 185 (19.8%) of the patients died. Time from frostbite injury to death ranged from 5 days to 17 years. Mortality between unhoused and housed frostbite patients was similar (19.7% vs 20.2%), but unhoused individuals died at significantly younger ages. Age was a significant predictor of mortality, while sex, race, and alcohol abuse were not. Living situation and drug use showed a trend toward increased mortality risk, but did not reach significance. The model (LR chi2 = 150.43, P < .001) indicated that the combined set of predictors significantly explained the variability in mortality risk. Findings highlight the need for targeted healthcare strategies to address socioeconomic disparities and improve outcomes for unhoused persons.