Housing and Food Insecurity, Care Access, and Health Status Among the Chronically Ill: An Analysis of the Behavioral Risk Factor Surveillance System

J Gen Intern Med. 2018 May;33(5):644-650. doi: 10.1007/s11606-017-4255-z. Epub 2018 Jan 3.


Background: The proportion of the United States population with chronic illness continues to rise. Understanding the determinants of quality of care-particularly social determinants-is critical to the provision of care in this population.

Objective: To estimate the prevalence of housing and food insecurity among persons with common chronic conditions and to assess the independent effects of chronic illness and sociodemographic characteristics on (1) housing and food insecurity, and (2) health care access hardship and health status.

Design: Cross-sectional study.

Participants: We used data from the 11 states and one territory that completed the social context module of the 2015 Behavioral Risk Factor Surveillance System (BRFSS).

Main measures: We estimated the prevalence of housing and food insecurity among patients with cancer, stroke, cardiovascular disease, and chronic lung disease. Logistic regression models were used to assess the independent effects of housing and food insecurity, chronic conditions, and demographics on health care access and health status.

Key results: Among the chronically ill, 36.71% (95% CI: 35.54-37.88) experienced housing insecurity and 30.60% (95% CI: 29.49-31.71) experienced food insecurity. Cardiovascular and lung disease increased the likelihood of housing (OR 1.69, 95% CI: 1.07-2.66 and OR 1.71, 95% CI: 1.12-2.60, respectively) and food insecurity (OR 1.75, 95% CI: 1.12-2.73 and OR 1.78, 95% CI: 1.20-2.63, respectively). Housing and food insecurity significantly increased the risk of health care access hardship. Being insured or having an income level above 200% of the federal poverty level significantly reduced the likelihood of access hardship, while female gender significantly increased the likelihood.

Conclusions: Chronic illness independently affects housing and food insecurity. In turn, food and housing anxiety leads to reduced access to care, likely due to cost concerns, and correlates with poorer health. A more complete understanding of the pathways by which chronic illness influences social determinants and clinical outcomes is needed.

Keywords: COPD; cardiovascular disease; chronic disease; health care access; health care cost; health status; homelessness; social determinants of health; stroke.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Adult
  • Chronic Disease / economics
  • Chronic Disease / epidemiology
  • Cross-Sectional Studies
  • Female
  • Food Supply / statistics & numerical data*
  • Health Services Accessibility / statistics & numerical data*
  • Health Surveys
  • Housing / statistics & numerical data*
  • Humans
  • Male
  • Middle Aged
  • Poverty / psychology
  • Poverty / statistics & numerical data
  • Risk Factors
  • Social Determinants of Health*
  • United States / epidemiology
  • Young Adult