Housing instability and food insecurity as barriers to health care among low-income Americans

J Gen Intern Med. 2006 Jan;21(1):71-7. doi: 10.1111/j.1525-1497.2005.00278.x.

Abstract

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.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Aged
  • Female
  • Food Supply
  • Health Services / statistics & numerical data*
  • Health Services Accessibility / economics*
  • Housing / economics
  • Housing / statistics & numerical data*
  • Humans
  • Hunger*
  • Ill-Housed Persons / statistics & numerical data*
  • Logistic Models
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Poverty* / ethnology
  • Socioeconomic Factors