Journal of General Internal Medicine

, Volume 28, Issue 1, pp 91–98 | Cite as

Food Insecurity Is Associated with Greater Acute Care Utilization among HIV-Infected Homeless and Marginally Housed Individuals in San Francisco

  • Sheri D. Weiser
  • Abigail Hatcher
  • Edward A. Frongillo
  • David Guzman
  • Elise D. Riley
  • David R. Bangsberg
  • Margot B. Kushel
Original Research

Abstract

Background

Food insecurity, or the uncertain availability of nutritionally adequate, safe foods, has been associated with poor HIV outcomes. There are few data on the extent to which food insecurity impacts patterns of health-care utilization among HIV-infected individuals.

Objective

We examined whether food insecurity was associated with hospitalizations, Emergency Department (ED) visits, and non-ED outpatient visits.

Methods

HIV-infected, homeless and marginally housed individuals participating in the San Francisco Research on Access to Care in the Homeless (REACH) cohort underwent quarterly structured interviews and blood draws. We measured food insecurity with the validated Household Food Insecurity Access Scale, and categorized participants as food secure, mild/moderately food insecure, and severely food insecure. Primary outcomes were: (1) any hospitalizations, (2) any ED visits, and (3) any non-ED outpatient visits. Generalized estimating equations were used to estimate model parameters, adjusting for socio-demographic (age, sex, ethnicity, education, income, housing status, health insurance) and clinical variables (CD4 nadir, time on antiretroviral therapy, depression, and illicit drug use).

Results

Beginning in November 2007, 347 persons were followed for a median of 2 years. Fifty-six percent of participants were food insecure at enrollment. Compared with food-secure persons, those with severe food insecurity had increased odds of hospitalizations [adjusted odds ratio (AOR) = 2.16, 95 % confidence interval (CI) = 1.50–3.09] and ED visits (AOR = 1.71, 95 % CI = 1.06–2.30). While the odds of an outpatient visit were 41 % higher for severely food insecure individuals, the effect was not statistically significant (AOR = 1.41, 95 % CI = 0.99–2.01). Mild/moderate food insecurity was also associated with increased hospitalizations (AOR = 1.56, 95 % CI = 1.06–2.30), ED visits (AOR = 1.57, 95 % CI = 1.22–2.03), and outpatient visits (AOR = 1.68, 95 % CI = 1.20–2.17).

Conclusions

Food insecurity is associated with increased health services utilization among homeless and marginally housed HIV-infected individuals in San Francisco. Increased ED visits and hospitalizations are not related to fewer ambulatory care visits among food-insecure individuals. Addressing food insecurity should be a critical component of HIV treatment programs and may reduce reliance on acute care utilization.

Key words

food security HIV/AIDS acute care utilization 

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Copyright information

© Society of General Internal Medicine 2012

Authors and Affiliations

  • Sheri D. Weiser
    • 1
    • 2
  • Abigail Hatcher
    • 1
  • Edward A. Frongillo
    • 3
  • David Guzman
    • 4
  • Elise D. Riley
    • 1
  • David R. Bangsberg
    • 5
  • Margot B. Kushel
    • 4
  1. 1.Division of HIV/AIDS, San Francisco General HospitalUniversity of California, San Francisco (UCSF)San FranciscoUSA
  2. 2.Center for AIDS Prevention StudiesUniversity of California, San Francisco (UCSF)San FranciscoUSA
  3. 3.Department of Health Promotion, Education, and Behavior, Arnold School of Public HealthUniversity of South CarolinaColumbiaUSA
  4. 4.Division of General Internal Medicine, San Francisco General HospitalUniversity of California, San Francisco (UCSF)San FranciscoUSA
  5. 5.Massachusetts General Hospital Center for Global Health, Ragon Institute of MGH, MIT and HarvardHarvard Medical SchoolBostonUSA

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