(P-PB-2) Homeless Patients Experience Disparate RBC Transfusion Administration Practices

Background/Case Studies: Patients experiencing homelessness are a vulnerable population and face a disproportionate burden of chronic health conditions. Numerous studies have focused on medical and psychiatric diseases in homeless patients, but none have assessed whether homeless patients are transfused at the same hemoglobin thresholds as domiciled patients. Housing status affects discharge plans may lead clinicians to transfuse more RBCs to homeless patients in an attempt to improve their functional status. As a safety net hospital system, we sought to assess whether our homeless patients experience disparities in RBC transfusion practice.

Study

Design/Methods: We performed a retrospective analysis of all RBC transfusions from 11 acute care hospitals performed in 2024. Patients were sorted by self-identified housing status (homeless vs domiciled) and sex. The pre-transfusion hemoglobin (pre-Tx Hb) levels tied to the transfusions were compared. Results were assessed using the Student’s T-test.

Results/Findings: 41,884 RBC units were transfused. 39,756 had a documented pre-Tx Hb with a mean of 7.342 g/dL. Homeless patients were transfused 3846 RBCs (9.18%) and 3757 had a documented pre-Tx Hb with a mean pre-Tx Hb of 7.232 g/dL. Domiciled patients were transfused 38,038 RBCs (90.82%), and 36,001 had a documented pre-Tx Hb with a mean pre-Tx Hb of 7.353 g/dL. Homeless patients were transfused RBCs at statistically significantly lower mean pre-Tx Hb levels (p-value < 0.0047) than domiciled patients. 27.09% of homeless patients self-identified as female and 72.91% as male. The mean pre-Tx Hb of homeless females was 7.341 g/dL, homeless males was 7.191 g/dL, domiciled females was 7.171 g/dL, and domiciled males was 7.525 g/dL. Homeless males were transfused RBCs at statistically significantly lower mean pre-Tx Hb levels than domiciled males (p-value=7.44X10^-10). Homeless females were transfused at higher mean pre-Tx Hb levels than domiciled females (p-value=1.42X10^-7).

Conclusions: Within our system despite standardized transfusion indications, homeless patients were transfused RBCs at a lower mean pre-Tx Hb level than domiciled patients. Domiciled males were the most likely to be transfused RBCs (mean pre-Tx Hb of 7.525 g/dL) and domiciled females were the least likely to be transfused (mean pre-Tx Hb of 7.171 g/dL). Homeless males were transfused RBCs at statistically significantly lower mean pre-Tx Hb levels than domiciled males. Homeless females were transfused RBCs at statistically significantly higher mean pre-Tx Hb levels than domiciled females. Additional studies are required to determine if clinicians are actively considering housing status or if unconscious bias is impacting their decision to transfuse RBCs.