Housing instability and food insecurity as barriers to health care among low-income Americans
Housing instability and food insecurity as barriers to health care among low-income Americans
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DOI：
10.1111/j.1525-1497.2005.00278.x
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发表时间：
2006-01-01
影响因子：
5.7
通讯作者：
Haas, JS
中科院分区：
文献类型：
--
作者：
Kushel, MB;Gupta, R;Haas, JS
背景：无家可归和饥饿与不良的健康结果有关。住房不稳定和食品不安全描述了确保住房和食品安全的不那么严重的问题。目的：确定住房不稳定和食品不安全、获得流动医疗保健的机会和紧急医疗保健利用率之间的联系。设计：全国美国家庭调查的次要数据分析。研究对象：16,651名低收入成年人。测量：自我报告的过去一年获得情况的测量：(1)没有通常的护理来源，(2)推迟所需的医疗保健。或(3)推迟用药；以及过去一年的使用情况：(1)没有门诊就诊，(2)有急诊科就诊，(3)住院。结果：23.6%的受试者住房不稳定，42.7%的受试者有食物不安全。在多因素Logistic回归模型中，住房不稳定与没有通常的护理来源(调整后的优势比[AOR]1.31，95%可信区间[CI]1.08至1.59)、推迟需要的医疗护理(AOR 1.84，95%CI 1.46至2.31)和推迟服药(AOR 2.16，95%CI 1.70至2.74)独立相关。增加急诊室使用率(AOR：1.43，95%CI为1.20至1.70)和住院率(AOR为1.30，95%CI为1.01至1.67)。粮食不安全独立地与推迟所需医疗护理有关(AOR 1.74。95%可信区间1.38至2.21)和推迟用药(AOR 2.15。95%可信区间1.62~2.85)，ED使用率增加(AOR 1.39，95%可信区间1.17~1.66)。和住院率(AOR 1.42，95%CI 1.09~1.85)。结论：住房不稳定和食物不安全与获得门诊护理的机会较少和急性护理的高比率有关。这些相互竞争的生活需求可能会导致延迟寻求护理，并容易患上急性护理。
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.