Skip to main content

Advertisement

SpringerLink
Log in

Residential Stability Reduces Unmet Health Care Needs and Emergency Department Utilization among a Cohort of Homeless and Vulnerably Housed Persons in Canada

  • Published:
Journal of Urban Health Aims and scope Submit manuscript

Abstract

This study examined the association of housing status over time with unmet physical health care needs and emergency department utilization among homeless and vulnerably housed persons in Canada. Homeless and vulnerably housed individuals completed interviewer-administered surveys on housing, unmet physical health care needs, health care utilization, sociodemographic characteristics, substance use, and health conditions at baseline and annually for 4 years. Generalized logistic mixed effects regression models examined the association of residential stability with unmet physical health care needs and emergency department utilization, adjusting for potential confounders. Participants were from Vancouver (n = 387), Toronto (n = 390), and Ottawa (n = 396). Residential stability was associated with lower odds of having unmet physical health needs (adjusted odds ratio (AOR), 0.82; 95 % confidence interval (CI), 0.67, 0.98) and emergency department utilization (AOR, 0.74; 95 % CI, 0.62, 0.88) over the 4-year follow-up period, after adjusting for potential confounders. Residential stability is associated with fewer unmet physical health care needs and lower emergency department utilization among homeless and vulnerably housed individuals. These findings highlight the need to address access to stable housing as a significant determinant of health disparities.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

FIG. 1
FIG. 2
FIG. 3

Similar content being viewed by others

References

  1. LePage JP, Bradshaw LD, Cipher DJ, Crawford AM, Hoosyhar D. The effects of homelessness on Veterans’ health care service use: an evaluation of independence from comorbidities. Public Health. 2014; 128(11): 985–92. doi:10.1016/j.puhe.2014.07.004.

    Article  CAS  PubMed  Google Scholar 

  2. Garibaldi B, Conde-Martel A, O’Toole TP. Self-reported comorbidities, perceived needs, and sources for usual care for older and younger homeless adults. J Gen Intern Med. 2005; 20(8): 726–30. doi:10.1111/j.1525-1497.2005.0142.x.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Wagner J, Diehl K, Mutsch L, Loffler W, Burkert N, Freidl W. Health status and utilisation of the healthcare system by homeless and non-homeless people in Vienna. Health Soc Care Community. 2014; 22(3): 300–7. doi:10.1111/hsc.12083.

    Article  PubMed  Google Scholar 

  4. Stratigos AJ, Katsambas AD. Medical and cutaneous disorders associated with homelessness. Skinmed. 2003; 2(3): 168–72.

    Article  PubMed  Google Scholar 

  5. Grossberg AL, Carranza D, Lamp K, Chiu MW, Lee C, Craft N. Dermatologic care in the homeless and underserved populations: observations from the Venice Family Clinic. Cutis. 2012; 89(1): 25–32.

    PubMed  Google Scholar 

  6. Milloy MJ, Kerr T, Bangsberg DR, Buxton J, Parashar S, Guillemi S, et al. Homelessness as a structural barrier to effective antiretroviral therapy among HIV-seropositive illicit drug users in a Canadian setting. AIDS Patient Care STDS. 2012; 26(1): 60–7. doi:10.1089/apc.2011.0169.

  7. Palepu A, Gadermann A, Hubley AM, Farrell S, Gogosis E, Aubry T, et al. Substance use and access to health care and addiction treatment among homeless and vulnerably housed persons in three Canadian cities. PLoS ONE. 2013; 8(10): e75133. doi:10.1371/journal.pone.0075133.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Krausz RM, Clarkson AF, Strehlau V, Torchalla I, Li K, Schuetz CG. Mental disorder, service use, and barriers to care among 500 homeless people in 3 different urban settings. Soc Psychiatry Psychiatr Epidemiol. 2013; 48(8): 1235–43. doi:10.1007/s00127-012-0649-8.

    Article  PubMed  Google Scholar 

  9. Lebrun-Harris LA, Baggett TP, Jenkins DM, Sripipatana A, Sharma R, Hayashi AS, et al. Health status and health care experiences among homeless patients in federally supported health centers: findings from the 2009 patient survey. Health Serv Res. 2013; 48(3): 992–1017. doi:10.1111/1475-6773.12009.

    Article  PubMed  Google Scholar 

  10. Kertesz SG, McNeil W, Cash JJ, Desmond R, McGwin G Jr, Kelly J, et al. Unmet need for medical care and safety net accessibility among Birmingham’s homeless. J Urban Health. 2014; 91(1): 33–45. doi:10.1007/s11524-013-9801-3.

    Article  PubMed  Google Scholar 

  11. Khandor E, Mason K, Chambers C, Rossiter K, Cowan L, Hwang SW. Access to primary health care among homeless adults in Toronto, Canada: results from the Street Health survey. Open Med. 2011; 5(2): e94–103.

    PubMed  PubMed Central  Google Scholar 

  12. Reid KW, Vittinghoff E, Kushel MB. Association between the level of housing instability, economic standing and health care access: a meta-regression. J Care Poor Underserved. 2008; 19(4): 1212–28. doi:10.1353/hpu.0.0068.

    Article  Google Scholar 

  13. Teruya C, Longshore D, Andersen RM, Arangua L, Nyamathi A, Leake B, et al. Health and health care disparities among homeless women. Women Health. 2010; 50(8): 719–36. doi:10.1080/03630242.2010.532754.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Baggett TP, O’Connell JJ, Singer DE, Rigotti NA. The unmet health care needs of homeless adults: a national study. Am J Public Health. 2010; 100(7): 1326–33. doi:10.2105/AJPH.2009.180109.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Canavan R, Barry MM, Matanov A, Barros H, Gabor E, Greacen T, et al. Service provision and barriers to care for homeless people with mental health problems across 14 European capital cities. BMC Health Serv Res. 2012; 12: 222. doi:10.1186/1472-6963-12-222.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Martens WH. Vulnerable categories of homeless patients in Western societies: experience serious barriers to health care access. Med Law. 2009; 28(2): 221–39.

    PubMed  Google Scholar 

  17. Kushel MB, Gupta R, Gee L, Haas JS. Housing instability and food insecurity as barriers to health care among low-income Americans. J Gen Intern Med. 2006; 21(1): 71–7. doi:10.1111/j.1525-1497.2005.00278.x.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Hodgson KJ, Shelton KH, van den Bree MB. Mental health problems in young people with experiences of homelessness and the relationship with health service use: a follow-up study. Evid Based Ment Health. 2014; 17(3): 76–80. doi:10.1136/ebmental-2014-101810.

    Article  PubMed  Google Scholar 

  19. Vijayaraghavan M, Tochterman A, Hsu E, Johnson K, Marcus S, Caton CL. Health, access to health care, and health care use among homeless women with a history of intimate partner violence. J Community Health. 2012; 37(5): 1032–9. doi:10.1007/s10900-011-9527-7.

    Article  PubMed  Google Scholar 

  20. Hwang SW, Aubry T, Palepu A, Farrell S, Nisenbaum R, Hubley AM, et al. The health and housing in transition study: a longitudinal study of the health of homeless and vulnerably housed adults in three Canadian cities. Int J Public Health. 2011; 56(6): 609–23. doi:10.1007/s00038-011-0283-3.

    Article  CAS  Google Scholar 

  21. Ardilly P, Le Blanc D. Sampling and weighting a survey of homeless persons: a French example. Surv Methodol. 2001; 27(1): 109–18.

    Google Scholar 

  22. Tsemberis S, McHugo G, Williams V, Hanrahan P, Stefancic A. Measuring homelessness and residential stability: the residential time-line follow-back inventory. J Community Psychol. 2007; 35(1): 29–42. doi:10.1002/jcop.20132.

    Article  Google Scholar 

  23. French MT, Roebuck MC, McGeary KA, Chitwood DD, McCoy CB. Using the drug abuse screening test (DAST-10) to analyze health services utilization and cost for substance users in a community-based setting. Subst Use Misuse. 2001; 36(6–7): 927–46.

    Article  CAS  PubMed  Google Scholar 

  24. Yudko E, Lozhkina O, Fouts A. A comprehensive review of the psychometric properties of the drug abuse screening test. J Subst Abuse Treat. 2007; 32(2): 189–98. doi:10.1016/j.jsat.2006.08.002.

    Article  PubMed  Google Scholar 

  25. Maisto SA, Carey MP, Carey KB, Gordon CM, Gleason JR. Use of the AUDIT and the DAST-10 to identify alcohol and drug use disorders among adults with a severe and persistent mental illness. Psychol Assess. 2000; 12(2): 186–92. doi:10.1037/1040-3590.12.2.186.

    Article  CAS  PubMed  Google Scholar 

  26. Barbor TF, de la Fuente JR, Saunders J, Grant M. AUDIT: the alcohol use disorders identification test: guidelines for use in primary health care. Geneva, Switzerland: World Health Organization; 1992.

    Google Scholar 

  27. Donovan DM, Kivlahan DR, Doyle SR, Longabaugh R, Greenfield SF. Concurrent validity of the Alcohol Use Disorders Identification Test (AUDIT) and AUDIT zones in defining levels of severity among out-patients with alcohol dependence in the COMBINE study. Addiction. 2006; 101(12): 1696–704. doi:10.1111/j.1360-0443.2006.01606.x.

    Article  PubMed  Google Scholar 

  28. The Health and Housing in Transition (HHiT) Study Team. Housing definitions and housing variables. University of Toronto TSpace. https://tspace.library.utoronto.ca/handle/1807/69938. Published 2015. Accessed 12 Feb 2016.

  29. Lasser KE, Himmelstein DU, Woolhandler S. Access to care, health status, and health disparities in the United States and Canada: results of a cross-national population-based survey. Am J Public Health. 2006; 96(7): 1300–7. doi:10.2105/AJPH.2004.059402.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Sanmartin C, Houle C, Tremblay S, Berthelot JM. Changes in unmet health care needs. Health Rep. 2002; 13(3): 15–21.

    PubMed  Google Scholar 

  31. Hwang SW, Ueng JJ, Chiu S, Kiss A, Tolomiczenko G, Cowan L, et al. Universal health insurance and health care access for homeless persons. Am J Public Health. 2010; 100(8): 1454–61. doi:10.2105/AJPH.2009.182022.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Hwang SW, Chambers C, Katic M. Accuracy of self-reported health care use in a population-based sample of homeless adults. Health Serv Res. 2016; 51(1): 282–301. doi:10.1111/1475-6773.12329.

    Article  PubMed  Google Scholar 

  33. Stahre M, VanEenwyk J, Siegel P, Njai R. Housing insecurity and the association with health outcomes and unhealthy behaviors, Washington State, 2011. Prev Chronic Dis. 2015; 12, E109. doi:10.5888/pcd12.140511.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Hwang SW, Chambers C, Chiu S, Katic M, Kiss A, Redelmeier DA, et al. A comprehensive assessment of health care utilization among homeless adults under a system of universal health insurance. Am J Public Health. 2013; 103(Suppl 2): S294–301. doi:10.2105/AJPH.2013.301369.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Tsai J, Doran KM, Rosenheck RA. When health insurance is not a factor: national comparison of homeless and nonhomeless US veterans who use Veterans Affairs Emergency Departments. Am J Public Health. 2013; 103(Suppl 2): S225–31. doi:10.2105/AJPH.2013.301307.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Duchon LM, Weitzman BC, Shinn M. The relationship of residential instability to medical care utilization among poor mothers in New York City. Med Care. 1999; 37(12): 1282–93.

    Article  CAS  PubMed  Google Scholar 

  37. Aidala AA, Wilson MG, Shubert V, Gogolishvili D, Globerman J, Rueda S, et al. Housing status, medical care, and health outcomes among people living with HIV/AIDS: a systematic review. Am J Public Health. 2016; 106(1): 95. doi:10.2105/AJPH.2015.302905a.

    Article  Google Scholar 

  38. Kushel MB, Perry S, Bangsberg D, Clark R, Moss AR. Emergency department use among the homeless and marginally housed: results from a community-based study. Am J Public Health. 2002; 92(5): 778–84.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Aubry T, Tsemberis S, Adair CE, Veldhuizen S, Streiner D, Latimer E, et al. One-year outcomes of a randomized controlled trial of housing first with ACT in five Canadian cities. Psychiatr Serv. 2015; 66(5): 463–9. doi:10.1176/appi.ps.201400167.

    Article  PubMed  Google Scholar 

  40. Kessell ER, Bhatia R, Bamberger JD, Kushel MB. Public health care utilization in a cohort of homeless adult applicants to a supportive housing program. J Urban Health. 2006; 83(5): 860–73. doi:10.1007/s11524-006-9083-0.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Raven MC, Doran KM, Kostrowski S, Gillespie CC, Elbel BD. An intervention to improve care and reduce costs for high-risk patients with frequent hospital admissions: a pilot study. BMC Health Serv Res. 2011; 11: 270. doi:10.1186/1472-6963-11-270.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Rosella LC, Fitzpatrick T, Wodchis WP, Calzavara A, Manson H, Goel V. High-cost health care users in Ontario, Canada: demographic, socio-economic, and health status characteristics. BMC Health Serv Res. 2014; 14: 532. doi:10.1186/s12913-014-0532-2.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgments

This study was funded by the Canadian Institutes for Health Research. We would like to acknowledge the following individuals from our community partner organizations: Street Health (Laura Cowan, Erika Khandor, Stephanie Gee), PHS Community Services Society (Liz Evans, Clare Hacksel), and Ottawa Inner City Health (Wendy Muckle). The authors also thank the study coordinators and interviewers in each of the three cities as well as the shelter, drop-in, and municipal and provincial staff for their assistance with participant recruitment and follow-up. We also thank Dr. Hubert Wong for his guidance on the statistical analyses. We are especially grateful to the health and housing in transition study participants for their contribution to these data.

Author information

Authors and Affiliations

  1. Department of Medicine, University of British Columbia, Vancouver, BC, Canada

    Denise Jaworsky, Trudy E. Naismith & Anita Palepu

  2. Centre for Health Evaluation and Outcome Sciences, St. Paul’s Hospital, 588-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada

    Anne Gadermann, Monica Norena & Anita Palepu

  3. Université de Montréal, Montréal, QC, Canada

    Arnaud Duhoux

  4. Centre for Research in Inner City Health, St. Michael’s Hospital, Toronto, ON, Canada

    Matthew J. To & Stephen W. Hwang

  5. Department of Medicine, University of Toronto, Toronto, ON, Canada

    Stephen W. Hwang

Authors
  1. Denise Jaworsky
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Anne Gadermann
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Arnaud Duhoux
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Trudy E. Naismith
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Monica Norena
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Matthew J. To
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Stephen W. Hwang
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Anita Palepu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Anita Palepu.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Jaworsky, D., Gadermann, A., Duhoux, A. et al. Residential Stability Reduces Unmet Health Care Needs and Emergency Department Utilization among a Cohort of Homeless and Vulnerably Housed Persons in Canada. J Urban Health 93, 666–681 (2016). https://doi.org/10.1007/s11524-016-0065-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11524-016-0065-6

Keywords

Search

Navigation