Food Insecurity Is Associated with Greater Acute Care Utilization among HIV-Infected Homeless and Marginally Housed Individuals in San Francisco
- 904 Downloads
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.
We examined whether food insecurity was associated with hospitalizations, Emergency Department (ED) visits, and non-ED outpatient visits.
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).
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).
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 wordsfood security HIV/AIDS acute care utilization
This publication was made possible by grant no. UL1 RR024131 from the National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH) and NIH Roadmap for Medical Research. Its contents are solely the responsibility of the authors and do not necessarily represent the official view of the NCRR or the NIH. Information on NCRR is available at http:///www.ncrr.nih.gov.
We thank the collaborating researchers including Kathleen McCartney, Richard Clark, Greg Barnell, John Day, Nelia Dela Cruz, Minoo Gorji, Scot Hammond, Jackie Haslam, Zizi Hawthorne, Jay Jankowski, Rhonda Johnson, Mac McMaster, Sandra Monk, Rebecca Packard, Joyce Powell, Kathleen Ragland, Mathew Reynolds, Paul Rueckhaus, Jacqueline So, John Weeks and Kelly Winslow.
NIMH 54907, 79713-01; CHRP ID08-SF-054; UCSF Academic Senate; Hurlbut-Johnson funds from AIDS Research Institute award, UCSF, no. 557858-8-148. The authors acknowledge the following additional sources of salary support: the Burke Family Foundation and the Hellman Family Foundation (to Dr. Weiser), and K24 MH-87227 (to Dr. Bangsberg).
Conflict of Interest
The authors declare that they do not have a conflict of interest.
- 11.Losina E, Schackman BR, Sadownik SN, et al. Racial and sex disparities in life expectancy losses among HIV-infected persons in the united states: impact of risk behavior, late initiation, and early discontinuation of antiretroviral therapy. Clin Infect Dis. 2009;49(10):1570–8.PubMedCrossRefGoogle Scholar
- 23.Maes KC, Hadley C, Tesfaye F, Shifferaw S. Food insecurity and mental health: Surprising trends among community health volunteers in Addis Ababa, Ethiopia during the 2008 food crisis. Soc Sci Med. Feb 12 2010.Google Scholar
- 36.Anema A, Weiser SD, Fernandes KA, Brandson EK, Montaner JS, Hogg RS. High prevalence of food insecurity among HIV-infected individuals receiving HAART in a resource-rich setting. AIDS Care. 2010 (In Press).Google Scholar
- 37.Vogenthaler NS, Hadley C, Rodriguez AE, Valverde EE, Del Rio C, Metsch LR. Depressive symptoms and food insufficiency among HIV-Infected crack users in Atlanta and Miami. AIDS Behav. Jan 23 2010.Google Scholar
- 46.Coates J, Swindale A, Bilinsky P. Household food insecurity access scale (HFIAS) for measurement of food access: indicator guide. Washington, DC: Food and Nutrition Technical Assistance. Academy for Educational Development; 2006.Google Scholar
- 51.National Institute on Alcohol Abuse and Alcoholism. The Physician’s Guide to Helping Patients with Alcohol Problems. 1995.Google Scholar
- 58.Nord M, Coleman-Jensen A, Andrews M, Carlson S. Household food security in the United States, 2009. Washington DC: United States Department of Agriculture (USDA);2010.Google Scholar
- 64.Betz ME, Gebo KA, Barber E, et al. Patterns of diagnoses in hospital admissions in a multistate cohort of HIV-positive adults in 2001. Med Care. Sep 2005;43(9 Suppl):III3–14.Google Scholar
- 80.Hamilton WL, Lin BH. Effects of food assistance and nutrition programs on nutrition and health: Volume 3, Literature Review. Food Assistance and Nutrition Research Reports. 2004.Google Scholar
- 83.USDA. Trends in Supplemental Nutrition Assistance Program participation rates: Fiscal Years 2002–2009 2011; http://www.fns.usda.gov/ora/menu/Published/snap/SNAPPartNational.htm. Accessed 9 June, 2012.
- 84.Coleman-Jensen A, Nord M, Andrews M, Carlson S. Household food security in the United States, 2010. Washington DC: United States Department of Agriculture (USDA);2011.Google Scholar
- 85.Fremstad S. A Modern Framework for Measuring Poverty and Basic Economic Security. Washington, DC: Center for Economic and Policy Research;2010.Google Scholar
- 86.Heflin CM, Mueser P. Assessing the Impact of a Modernized ApplicationProcess on Florida’s Food Stamp Caseload. Lexington: University of Kentucky Center for PovertyResearch;2010.Google Scholar