Journal of General Internal Medicine

, Volume 26, Issue 6, pp 627–634 | Cite as

Food Insufficiency and Health Services Utilization in a National Sample of Homeless Adults

  • Travis P. BaggettEmail author
  • Daniel E. Singer
  • Sowmya R. Rao
  • James J. O’Connell
  • Monica Bharel
  • Nancy A. Rigotti
Original Research


Homeless people have high rates of hospitalization and emergency department (ED) use. Obtaining adequate food is a common concern among homeless people and may influence health care utilization.


We tested the hypothesis that food insufficiency is related to higher rates of hospitalization and ED use in a national sample of homeless adults.


We analyzed data from the 2003 Health Care for the Homeless (HCH) User Survey.


Participants were 966 adults surveyed at 79 HCH clinic sites throughout the US. The study sample was representative of over 436,000 HCH clinic users nationally.


We determined the prevalence and characteristics of food insufficiency among respondents. Using multivariable logistic regression, we examined the association between food insufficiency and four past-year acute health services utilization outcomes: (1) hospitalization for any reason, (2) psychiatric hospitalization, (3) any ED use, and (4) high ED use (≥4 visits).


Overall, 25% of respondents reported food insufficiency. Among them, 68% went a whole day without eating in the past month. Chronically homeless (p = 0.01) and traumatically victimized (p = 0.001) respondents were more likely to be food insufficient. In multivariable analyses, food insufficiency was associated with significantly greater odds of hospitalization for any reason (AOR 1.59, 95% CI 1.07, 2.36), psychiatric hospitalization (AOR 3.12, 95% CI 1.73, 5.62), and high ED utilization (AOR 2.83, 95% CI 1.32, 6.08).


One-fourth of homeless adults in this national survey were food insufficient, and this was associated with increased odds of acute health services utilization. Addressing the adverse health services utilization patterns of homeless adults will require attention to the social circumstances that may contribute to this issue.


homelessness food insufficiency health services utilization 



This study was funded by grant number T32HP10251 from the Health Resources and Services Administration of the Department of Health and Human Services to support the Harvard Medical School Fellowship in General Medicine and Primary Care. The views expressed in this publication are the opinions of the authors and do not necessarily reflect the official policies of the US Department of Health and Human Services or the Health Resources and Services Administration, nor does mention of the department or agency imply endorsement by the US government.

A preliminary summary of these findings was presented as a scientific abstract at the Society of General Internal Medicine 33rd Annual Meeting (Minneapolis, MN; April 28–May 1, 2010).

Conflicts of interest

None disclosed


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Copyright information

© Society of General Internal Medicine 2011

Authors and Affiliations

  • Travis P. Baggett
    • 1
    • 2
    • 3
    Email author
  • Daniel E. Singer
    • 1
    • 2
  • Sowmya R. Rao
    • 4
  • James J. O’Connell
    • 3
    • 1
    • 2
  • Monica Bharel
    • 3
    • 1
    • 2
  • Nancy A. Rigotti
    • 1
    • 2
  1. 1.General Medicine DivisionMassachusetts General HospitalBostonUSA
  2. 2.Department of MedicineHarvard Medical SchoolBostonUSA
  3. 3.Boston Health Care for the Homeless ProgramBostonUSA
  4. 4.Biostatistics CenterMassachusetts General HospitalBostonUSA

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