Journal of General Internal Medicine

, Volume 21, Issue 1, pp 71–77

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

  • Margot B. Kushel
  • Reena Gupta
  • Lauren Gee
  • Jennifer S. Haas
Populations At Risk

DOI: 10.1111/j.1525-1497.2005.00278.x

Cite this article as:
Kushel, M.B., Gupta, R., Gee, L. et al. J GEN INTERN MED (2006) 21: 71. doi:10.1111/j.1525-1497.2005.00278.x


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.

Key Words

homelessnesshungeraccess to caredisparities

Copyright information

© Society of General Internal Medicine 2006

Authors and Affiliations

  • Margot B. Kushel
    • 1
  • Reena Gupta
    • 2
  • Lauren Gee
    • 1
  • Jennifer S. Haas
    • 3
  1. 1.Division of General Internal MedicineUCSF/San Francisco General HospitalSan FranciscoUSA
  2. 2.Harvard Medical SchoolBostonUSA
  3. 3.Division of General MedicineBrigham and Women’s Hospital, Harvard Medical SchoolBostonUSA