Migration to the Downtown Eastside neighbourhood of Vancouver and changes in service use in a cohort of mentally ill homeless adults: a 10-year retrospective study
Migration to the Downtown Eastside neighbourhood of Vancouver and changes in service use in a cohort of mentally ill homeless adults: a 10-year retrospective study
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DOI：
10.1136/bmjopen-2015-009043
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发表时间：
2016-01-01
期刊：
影响因子：
2.9
通讯作者：
Rezansoff, Stefanie N.
中科院分区：
文献类型：
--
作者：
Somers, Julian M.;Moniruzzaman, Akm;Rezansoff, Stefanie N.
目标：很少有研究调查移民作为具有复杂健康和社会需求的无家可归者空间集中的潜在因素的作用。此外，人们对可能的迁移与服务使用水平随时间变化之间的关系知之甚少。我们假设生活在集中城市环境中的无家可归者、精神病患者在 10 年间从其他地方迁移，这与公共服务使用量的显着增加有关。背景：招募集中在加拿大温哥华市中心东区社区。参与者：参与者 (n=433) 符合长期无家可归和严重精神疾病的标准，并同意访问管理数据。方法：链接 使用行政数据来回顾性审查招募前十年内每年的地理搬迁以及卫生、司法和社会福利服务利用率。使用广义估计方程来估计移民对服务使用的影响。结果：在 10 年期间，温哥华市中心东区社区出现大量人口迁移（从该群体的 17% 增加到 52%）。同期，社区医疗服务（每年调整后费率比（ARR）=1.08；95% CI 1.06至1.10）、住院人数（ARR=1.08；95% CI 1.04至1.11）、刑事定罪（ARR=1.08；95% CI 1.03至1.13）和经济援助支出逐年显着增加。 （ARR=1.04；95% CI 1.03 至 1.06）。移民与经济援助显着相关，但与其他类型的服务无关。结论：十年期间服务使用的显着增加与大量移民到相关服务集中的城市地区同时发生。这些结果凸显了对空间多样化的社区进行早期干预的机会，以中断健康状况恶化和服务参与度极高的轨迹。迫切需要进一步研究来调查实际移民、健康和社会福利以及公共服务的不断使用之间的因果关系。
Objectives: Little research has investigated the role of migration as a potential contributor to the spatial concentration of homeless people with complex health and social needs. In addition, little is known concerning the relationship between possible migration and changes in levels of service use over time. We hypothesised that homeless, mentally ill individuals living in a concentrated urban setting had migrated from elsewhere over a 10-year period, in association with significant increases in the use of public services.Setting: Recruitment was concentrated in the Downtown Eastside neighbourhood of Vancouver, Canada.Participants: Participants (n=433) met criteria for chronic homelessness and serious mental illness, and provided consent to access administrative data.Methods: Linked administrative data were used to retrospectively examine geographic relocation as well as rates of health, justice, and social welfare service utilisation in each of the 10 years prior to recruitment. Generalised estimating equations were used to estimate the effect of migration on service use.Results: Over a 10-year period there was significant movement into Vancouver's Downtown Eastside neighbourhood (from 17% to 52% of the cohort). During the same period, there were significant annual increases in community medical services (adjusted rate ratio (ARR) per year=1.08; 95% CI 1.06 to 1.10), hospital admissions (ARR=1.08; 95% CI 1.04 to 1.11), criminal convictions (ARR=1.08; 95% CI 1.03 to 1.13), and financial assistance payments (ARR=1.04; 95% CI 1.03 to 1.06). Migration was significantly associated with financial assistance, but not with other types of services.Conclusions: Significant increases in service use over a 10-year period coincided with significant migration into an urban area where relevant services were concentrated. These results highlight opportunities for early intervention in spatially diverse neighbourhoods to interrupt trajectories marked by worsening health and extremely high service involvement. Further research is urgently needed to investigate the causal relationships between physical migration, health and social welfare, and escalating use of public services.