Housing and Food Insecurity, Care Access, and Health Status Among the Chronically Ill: An Analysis of the Behavioral Risk Factor Surveillance System
Housing and Food Insecurity, Care Access, and Health Status Among the Chronically Ill: An Analysis of the Behavioral Risk Factor Surveillance System
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DOI：
10.1007/s11606-017-4255-z
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发表时间：
2018-05-01
影响因子：
5.7
通讯作者：
Carlos, Ruth C.
中科院分区：
文献类型：
--
作者：
Charkhchi, Paniz;Dehkordy, Soudabeh Fazeli;Carlos, Ruth C.
美国患有慢性病的人口比例继续上升。了解医疗质量的决定因素--特别是社会决定因素--对于在这一人群中提供医疗服务至关重要。评估患有常见慢性病的人群中住房和食品不安全的流行情况，并评估慢性病和社会人口特征对(1)住房和食品不安全，以及(2)医疗保健困难和健康状况的独立影响。横断面研究：我们使用了来自11个州和一个地区的数据，这些州和地区完成了2015年行为风险因素监测系统(BRFSS)的社会背景模块。我们估计了癌症、中风、心血管疾病和慢性肺病患者的住房和食品不安全的患病率。在慢性病患者中，36.71%(95%CI：35.54~37.88)经历了住房不安全，30.60%(95%CI：29.49~31.71)经历了食物不安全。心血管疾病和肺病增加了住房(OR 1.69，95%CI：1.07-2.66和OR 1.71，95%CI：1.12-2.60)和食物不安全(OR 1.75，95%CI：1.12-2.73和OR 1.78，95%CI：1.20-2.63)的可能性。住房和粮食不安全大大增加了获得保健困难的风险。有保险或收入水平超过联邦贫困水平的200%显著降低了获得困难的可能性，而女性显著增加了获得困难的可能性。慢性疾病独立影响住房和食物的不安全。反过来，食物和住房焦虑导致获得护理的机会减少，这可能是由于成本问题，并与较差的健康相关。需要更全面地了解慢性病影响社会决定因素和临床结果的途径。
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.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.Cross-sectional study.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).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.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.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.