BACKGROUND: Homelessness and hunger are associated with poor health outcomes. Housing instability and food insecurity describe less severe problems securing housing and food. OBJECTIVE: To determine the association between housing instability and food insecurity and access to ambulatory health care and rates of acute health care utilization. DESIGN: Secondary data analysis of the National Survey of American Families. PARTICIPANTS: 16,651 low-income adults. MEASUREMENT: Self-reported measures of past-year access: (1) not having a usual source of care, (2) postponing needed medical care, or (3) postponing medication; and past-year utilization: (1) not having an ambulatory care visit, (2) having emergency department (ED) visits, or (3) inpatient hospitalization. RESULTS: 23.6% of subjects had housing instability and 42.7% had food insecurity. In multivariate logistic regression models, housing instability was independently associated with not having a usual source of care (adjusted odds ratio [AOR] 1.31, 95% confidence interval [CI] 1.08 to 1.59), postponing needed medical care (AOR 1.84, 95% CI 1.46 to 2.31) and postponing medications (AOR 2.16, 95% CI 1.70 to 2.74), increased ED use (AOR: 1.43, 95% CI 1.20 to 1.70), and hospitalizations (AOR 1.30, 95% CI 1.01 to 1.67). Food insecurity was independently associated with postponing needed medical care (AOR 1.74, 95% CI 1.38 to 2.21) and postponing medications (AOR 2.15, 95% CI 1.62 to 2.85), increased ED use (AOR 1.39, 95% CI 1.17 to 1.66), and hospitalizations (AOR 1.42, 95% CI 1.09 to 1.85). CONCLUSIONS: Housing instability and food insecurity are associated with poor access to ambulatory care and high rates of acute care. These competing life demands may lead to delays in seeking care and predispose to acute care.
BACKGROUND: Homelessness and hunger are associated with poor health outcomes. Housing instability and food insecurity describe less severe problems securing housing and food. OBJECTIVE: To determine the association between housing instability and food insecurity and access to ambulatory health care and rates of acute health care utilization. DESIGN: Secondary data analysis of the National Survey of American Families. PARTICIPANTS: 16,651 low-income adults. MEASUREMENT: Self-reported measures of past-year access: (1) not having a usual source of care, (2) postponing needed medical care, or (3) postponing medication; and past-year utilization: (1) not having an ambulatory care visit, (2) having emergency department (ED) visits, or (3) inpatient hospitalization. RESULTS: 23.6% of subjects had housing instability and 42.7% had food insecurity. In multivariate logistic regression models, housing instability was independently associated with not having a usual source of care (adjusted odds ratio [AOR] 1.31, 95% confidence interval [CI] 1.08 to 1.59), postponing needed medical care (AOR 1.84, 95% CI 1.46 to 2.31) and postponing medications (AOR 2.16, 95% CI 1.70 to 2.74), increased ED use (AOR: 1.43, 95% CI 1.20 to 1.70), and hospitalizations (AOR 1.30, 95% CI 1.01 to 1.67). Food insecurity was independently associated with postponing needed medical care (AOR 1.74, 95% CI 1.38 to 2.21) and postponing medications (AOR 2.15, 95% CI 1.62 to 2.85), increased ED use (AOR 1.39, 95% CI 1.17 to 1.66), and hospitalizations (AOR 1.42, 95% CI 1.09 to 1.85). CONCLUSIONS: Housing instability and food insecurity are associated with poor access to ambulatory care and high rates of acute care. These competing life demands may lead to delays in seeking care and predispose to acute care.
Authors: David U Himmelstein; Elizabeth Warren; Deborah Thorne; Steffie Woolhandler Journal: Health Aff (Millwood) Date: 2005 Jan-Jun Impact factor: 6.301
Authors: John T Cook; Deborah A Frank; Carol Berkowitz; Maureen M Black; Patrick H Casey; Diana B Cutts; Alan F Meyers; Nieves Zaldivar; Anne Skalicky; Suzette Levenson; Tim Heeren; Mark Nord Journal: J Nutr Date: 2004-06 Impact factor: 4.798
Authors: Rebecca T Brown; Edgar Pierluissi; David Guzman; Eric R Kessell; L Elizabeth Goldman; Urmimala Sarkar; Michelle Schneidermann; Jeffrey M Critchfield; Margot B Kushel Journal: J Am Geriatr Soc Date: 2014-11-03 Impact factor: 5.562
Authors: Wai Ting Chung; William T Gallo; Nancy Giunta; Maureen E Canavan; Nina S Parikh; Marianne C Fahs Journal: J Urban Health Date: 2012-06 Impact factor: 3.671
Authors: Travis P Baggett; Daniel E Singer; Sowmya R Rao; James J O'Connell; Monica Bharel; Nancy A Rigotti Journal: J Gen Intern Med Date: 2011-01-29 Impact factor: 5.128
Authors: Gilbert Saint-Jean; Lisa Metsch; Orlando Gomez-Marin; Colbert Pierre; Yves Jeanty; Allan Rodriguez; Robert Malow Journal: AIDS Care Date: 2011-04
Authors: Sheri D Weiser; Edward A Frongillo; Kathleen Ragland; Robert S Hogg; Elise D Riley; David R Bangsberg Journal: J Gen Intern Med Date: 2008-10-25 Impact factor: 5.128