Miriam Harris1, Anne Gadermann2,3, Monica Norena2, Matthew To4, Anita M Hubley5, Tim Aubry6, Stephen Hwang4,7, Anita Palepu8,9. 1. Division of General Internal Medicine, Department of Medicine, McGill University, Montreal, Canada. 2. Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, Canada. 3. School of Population and Public Health, University of British Columbia, Vancouver, Canada. 4. Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Canada. 5. Department of Education Counselling Psychology and Special Education, University of British Columbia, Vancouver, Canada. 6. School of Psychology, University of Ottawa, Ottawa, Canada. 7. Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, Canada. 8. Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, Canada. apalepu@hivnet.ubc.ca. 9. Division of General Internal Medicine, Department of Medicine, University of British Columbia, Vancouver, Canada. apalepu@hivnet.ubc.ca.
Abstract
OBJECTIVES: To determine the relationship between housing instability, as measured by the number of residential moves, with problematic substance use, unmet healthcare needs, and acute care utilization. METHODS: A cohort of homeless or vulnerably housed persons from Vancouver (n = 387), Toronto (n = 390), and Ottawa (n = 396) completed interviewer-administered surveys at baseline and annually for 4 years from 2009 to 2013. Generalized mixed effects logistic regression models were used to examine the association between the number of residential moves and each of the three outcome variables, adjusting for potential confounders. RESULTS: The number of residential moves was significantly associated with higher acute care utilization [adjusted odds ratio (AOR) 1.25; 95% confidence interval (CI) CI: 1.17-1.33], unmet healthcare needs (AOR 1.14; 95% CI: 1.07-1.22), and problematic substance use (AOR 1.26; 95% CI: 1.16-1.36). Having chronic physical or mental conditions and recent incarceration were also found to be associated with the outcomes. CONCLUSIONS: Housing instability increased the odds of all three poor health metrics, highlighting the importance of stable housing as a critical social determinant of health.
OBJECTIVES: To determine the relationship between housing instability, as measured by the number of residential moves, with problematic substance use, unmet healthcare needs, and acute care utilization. METHODS: A cohort of homeless or vulnerably housed persons from Vancouver (n = 387), Toronto (n = 390), and Ottawa (n = 396) completed interviewer-administered surveys at baseline and annually for 4 years from 2009 to 2013. Generalized mixed effects logistic regression models were used to examine the association between the number of residential moves and each of the three outcome variables, adjusting for potential confounders. RESULTS: The number of residential moves was significantly associated with higher acute care utilization [adjusted odds ratio (AOR) 1.25; 95% confidence interval (CI) CI: 1.17-1.33], unmet healthcare needs (AOR 1.14; 95% CI: 1.07-1.22), and problematic substance use (AOR 1.26; 95% CI: 1.16-1.36). Having chronic physical or mental conditions and recent incarceration were also found to be associated with the outcomes. CONCLUSIONS: Housing instability increased the odds of all three poor health metrics, highlighting the importance of stable housing as a critical social determinant of health.
Authors: Anne M Gadermann; Mohammad Ehsanul Karim; Monica Norena; Scott D Emerson; Anita M Hubley; Lara B Russell; Rosane Nisenbaum; Stephen W Hwang; Tim Aubry; Anita Palepu Journal: J Urban Health Date: 2020-04 Impact factor: 3.671
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