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

Journal of General Internal Medicine volume 21, pages 71–77 (2006)Cite this article

Abstract

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.

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Author information

Authors and Affiliations

  1. Division of General Internal Medicine, UCSF/San Francisco General Hospital, San Francisco, CA, USA

    Margot B. Kushel MD & Lauren Gee MPH, JD

  2. Harvard Medical School, Boston, MA, USA

    Reena Gupta MD

  3. Division of General Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Jennifer S. Haas MD, MSPH

Authors
  1. Margot B. Kushel MD
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  2. Reena Gupta MD
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  3. Lauren Gee MPH, JD
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  4. Jennifer S. Haas MD, MSPH
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Corresponding author

Correspondence to Margot B. Kushel MD.

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The authors have no conflicts of interest to declare for this article or this research.

See editorial by Arlenes Bierman and James R. Dunn, p. 99–100.

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Kushel, M.B., Gupta, R., Gee, L. et al. Housing instability and food insecurity as barriers to health care among low-income americans. J GEN INTERN MED 21, 71–77 (2006). https://doi.org/10.1111/j.1525-1497.2005.00278.x

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  • DOI: https://doi.org/10.1111/j.1525-1497.2005.00278.x

Key Words

  • homelessness
  • hunger
  • access to care
  • disparities