UMMS Affiliation

Department of Family Medicine and Community Health; Department of Population and Quantitative Health Sciences; Commonwealth Medicine, Center for Health Law and Policy

Publication Date


Document Type



Community Health and Preventive Medicine | Health Economics | Health Law and Policy | Health Policy | Health Services Administration | Health Services Research | Maternal and Child Health | Preventive Medicine


Homeless infants are known to have poor birth outcomes, but the longitudinal impact of homelessness on health, health care use, and health spending during the early years of life has received little attention. Linking Massachusetts emergency shelter enrollment records for the period 2008-15 with Medicaid claims, we compared 5,762 infants who experienced a homeless episode with a group of 5,553 infants matched on sex, race/ethnicity, location, and birth month. Infants born during a period of unstable housing resulting in homelessness had higher rates of low birthweight, respiratory problems, fever, and other common conditions; longer neonatal intensive care unit stays; more emergency department visits; and higher annual spending. Differences in most health conditions persisted for two to three years. Asthma diagnoses, emergency department visits, and spending were significantly higher through age six. While screening and access to health care can be improved for homeless infants, long-term solutions require a broader focus on housing and income.


homelessness, poverty, maternal and child health, social determinants of health

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Copyright Project HOPE—The People-to-People Health Foundation, Inc. This open access article is distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license.

DOI of Published Version



Health Aff (Millwood). 2019 May;38(5):721-728. doi: 10.1377/hlthaff.2019.00090. Link to article on publisher's site

Journal/Book/Conference Title

Health affairs (Project Hope)

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Link to Article in PubMed

PubMed ID


Creative Commons License

Creative Commons Attribution 4.0 License
This work is licensed under a Creative Commons Attribution 4.0 License.