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Canadian Journal of Public Health

, Volume 110, Issue 2, pp 127–138 | Cite as

Public housing and healthcare use: an investigation using linked administrative data

  • Aynslie M. HindsEmail author
  • Brian Bechtel
  • Jino Distasio
  • Leslie L. Roos
  • Lisa M. Lix
Population Health Intervention Research

Abstract

Objective

This study investigated whether a move to public housing affects people’s use of healthcare services.

Method

Using administrative data from Manitoba, the number of hospitalizations, general practitioner (GP), specialist and emergency department (ED) visits, and prescription drugs dispensed in the years before and after the housing move-in date (2012/2013) were measured for a public housing and matched cohort. Generalized linear models with generalized estimating equations tested for differences between the cohorts in utilization trends. The data were modeled using Poisson (rate ratio, RR), negative binomial (incident rate ratio, IRR), and binomial (odds ratio, OR) distributions.

Results

GP visits (IRR = 1.04, 95% CI 1.01–1.06) and prescriptions (IRR = 1.04, 95% CI 1.02–1.05) increased, while ED visits (RR = 0.90, 95% CI 0.82–1.00) and hospitalizations (OR = 0.95, 95% CI 0.93–0.96) decreased over time. The public housing cohort had a significantly higher rate of GP visits (IRR = 1.08, 95% CI 1.04–1.13), ED visits (RR = 1.18, 95% CI 1.01–1.37), and prescriptions (IRR = 1.09, 95% CI 1.05–1.13), and was more likely to be hospitalized (OR = 1.39, 95% CI 1.21–1.61) compared to the matched cohort. The rate of inpatient days significantly decreased for the public housing cohort, but did not change for the matched cohort.

Conclusion

Healthcare use changed similarly over time (except inpatient days) for the two cohorts. Public housing provides a basic need to a population who has a high burden of disease and who may not be able to obtain and maintain housing in the private market.

Keywords

Public housing Healthcare use Health services Health status Record linkage Administrative data 

Résumé

Objectif

Déterminer si l’installation dans un logement social a un effet sur l’utilisation des services de soins.

Méthode

À l’aide des données administratives du Manitoba, nous avons mesuré le nombre d’hospitalisations, de consultations d’omnipraticiens ou de spécialistes, de visites à l’urgence et de médicaments sur ordonnance délivrés dans les années qui précèdent et qui suivent la date d’installation dans un logement (2012–2013) pour une cohorte vivant dans des logements sociaux et une cohorte témoin. Les différences dans les tendances d’utilisation de chaque cohorte ont été testées par des modèles linéaires généralisés avec équations d’estimation généralisées. Les données ont été modélisées à l’aide d’analyses de régression de Poisson (rapport de taux, RT), de régression binomiale négative (rapport de taux d’incidence, RTI) et de régression binomiale (rapport de cotes, RC).

Résultats

Dans l’ensemble, les consultations d’omnipraticiens (RTI = 1,04, IC de 95% 1,01–1,06) et les médicaments sur ordonnance (RTI = 1,04, IC de 95% 1,02–1,05) ont augmenté, tandis que les visites à l’urgence (RT = 0,90, IC de 95% 0,82–1,00) et les hospitalisations (RC = 0,95, IC de 95% 0,93–0,96) ont diminué avec le temps. La cohorte des logements sociaux a présenté des taux sensiblement plus élevés de consultations d’omnipraticiens (RTI = 1,08, IC de 95% 1,04–1,13), de visites à l’urgence (RT = 1,18, IC de 95% 1,01–1,37) et de médicaments sur ordonnance (RTI = 1,09, IC de 95% 1,05–1,13) et une plus grande probabilité d’hospitalisation (RC = 1,39, IC de 95% 1,21–1,61) que la cohorte témoin. Le nombre de jours de traitement en établissement a sensiblement diminué dans la cohorte des logements sociaux, mais n’a pas changé dans la cohorte témoin.

Conclusion

L’utilisation des soins de santé a évolué de façon similaire dans les deux cohortes au fil du temps (sauf pour les jours de traitement en établissement). Le logement social comble un besoin fondamental pour une population qui présente une charge de morbidité élevée et qui n’a pas toujours les moyens de trouver et de garder un logement sur le marché privé.

Mots-clés

Logement social Utilisation des soins de santé Services de santé État de santé Couplage des dossiers médicaux Données administratives 

Notes

Acknowledgements

Thanks are owed to Heather Prior for data extraction from the Manitoba Centre for Health Policy Population Health Research Data Repository. Thanks are also owed to Kristine Kroeker for providing statistical consulting advice.

Funding information

This work was supported by funding to AMH from Research Manitoba (PhD Dissertation Award). LML was supported by a Manitoba Research Chair from Research Manitoba.

Compliance with ethical standards

Disclaimer

The authors acknowledge the Manitoba Centre for Health Policy for use of data contained in the Population Research Data Repository under project #2015-002 (HIPC#2014/2015.29). The results and conclusions are those of the authors and no official endorsement by the Manitoba Centre for Health Policy, Manitoba Health, or other data providers is intended or should be inferred. Data used in this study are from the Population Research Data Repository housed at the Manitoba Centre for Health Policy, University of Manitoba and were derived from data provided by Manitoba Health, the Winnipeg Regional Health Authority, and the Department of Families.

Ethics approval

Ethics approval was obtained from the University of Manitoba Health Research Ethics Board. Data access was approved by the Manitoba Health Information Privacy Committee.

Conflict of interest

The authors declare that they have no conflicts of interest.

Supplementary material

41997_2018_162_MOESM1_ESM.docx (14 kb)
ESM 1 (DOCX 13 kb)

References

  1. Andersen, R. M. (1995). Revisiting the behavioral model and access to medical care: does it matter? Journal of Health and Social Behavior, 36(1), 1–10.PubMedCrossRefGoogle Scholar
  2. Apparicio, P., Seguin, A., & Séguin, A. M. (2006). Measuring the accessibility of services and facilities for residents of public housing in Montréal. Urban Studies, 43(1), 187–211.  https://doi.org/10.1080/00420980500409334.CrossRefGoogle Scholar
  3. Aratani, Y. (2010). Public housing revisited: racial differences, housing assistance, and socioeconomic attainment among low-income families. Social Science Research, 39(6), 1108–1125.  https://doi.org/10.1016/j.ssresearch.2010.04.007.CrossRefGoogle Scholar
  4. Austin, P. C., Van Walraven, C., Wodchis, W. P., Newman, A., & Anderson, G. M. (2011). Using the Johns Hopkins Aggregated Diagnosis Groups (ADGs) to predict mortality in a general adult population cohort in Ontario, Canada. Medical Care, 49(10), 932–939.  https://doi.org/10.1097/MLR.0b013e318215d5e2.PubMedPubMedCentralCrossRefGoogle Scholar
  5. Baker, R. S., Bazargan, M., Bazargan-Hejazi, S., & Calderón, J. L. (2005). Access to vision care in an urban low-income multiethnic population. Ophthalmic Epidemiology, 12(1), 1–12.  https://doi.org/10.1080/09286580590921330.PubMedCrossRefGoogle Scholar
  6. Battaglia, T. A., Murrell, S. S., Bhosrekar, S. G., Caron, S. E., Bowen, D. J., Smith, E., … Rorie, J.-A. (2012). Connecting Boston’s public housing developments to community health centers: who’s ready for change? Progress in Community Health Partnerships: Research, Education, and Action, 6(3), 239–248.  https://doi.org/10.1353/cpr.2012.0035.
  7. Bazargan, M., Calderon, J. L., Heslin, K. C., Mentes, C., Shaheen, M. A., Ahdout, J., & Baker, R. S. (2005a). A profile of chronic mental and physical conditions among African-American and Latino children in urban public housing. Ethnicity & Disease, 15(Supplement), S5-3-S5-9.Google Scholar
  8. Bazargan, M., Norris, K., Bazargan-Hejazi, S., Akhanjee, L., Calderon, J. L., Safvati, S., & Baker, R. S. (2005b). Alternative healthcare use in the underserved population. Ethnicity & Disease, 15, 531–539.Google Scholar
  9. Black, B. S., Rabins, P. V., German, P., McGuire, M., & Roca, R. (1997). Need and unmet need for mental health care among elderly public housing residents. The Gerontologist, 37(6), 717–728.PubMedCrossRefGoogle Scholar
  10. Black, B. S. S., Rabins, P. V. V., German, P., Roca, R., McGuire, M., & Brant, L. J. J. (1998). Use of formal and informal sources of mental health care among older African-American public-housing residents. Psychological Medicine, 28(3), 519–530.  https://doi.org/10.1017/S0033291798006631.PubMedCrossRefGoogle Scholar
  11. Carder, P., Luhr, G., & Kohon, J. (2016). Differential health and social needs of older adults waitlisted for public housing or housing choice vouchers. Journal of Aging and Social Policy, 28(4), 246–260.  https://doi.org/10.1080/08959420.2016.1156507.PubMedCrossRefGoogle Scholar
  12. Cooper, H. L., Wodarski, S., Cummings, J., Hunter-Jones, J., Karnes, C., Ross, Z., … Bonney, L. E. (2012). Public housing relocations in Atlanta, Georgia, and declines in spatial access to safety net primary care. Health & Place, 18(6), 1255–1260.  https://doi.org/10.1016/j.healthplace.2012.08.007.
  13. Culhane-Pera, K., Ellmore, D., & Wessel, L. A. (2007). Primary care in public housing: voices of clinicians. Journal Of Health Care For The Poor And Underserved, 18, 735–743.PubMedCrossRefGoogle Scholar
  14. Cummings, J. R., Allen, L., Ko, M., Bonney, L., Hunter-Jones, J., & Cooper, H. (2016). Changes in healthcare access and utilization among participants in a public housing relocation program in Atlanta, Georgia. Health and Place, 42, 63–68.  https://doi.org/10.1016/j.healthplace.2016.07.006.PubMedCrossRefGoogle Scholar
  15. de Boer, A. G. E. M., Wijker, W., & de Haes, H. C. J. M. (1997). Predictors of health care utilization in the chronically ill: a review of the literature. Health Policy, 42, 101–115.PubMedCrossRefGoogle Scholar
  16. Diez Roux, A. V., Kiefe, C. I., Jacobs, D. R., Haan, M., Jackson, S. A., Nieto, F. J., … Schulz, R. (2001). Area characteristics and individual-level socioeconomic position indicators in three population-based epidemiologic studies. Annals of Epidemiology, 11(6), 395–405.  https://doi.org/10.1016/S1047-2797(01)00221-6.
  17. Digenis-Bury, E. C., Brooks, D. R., Chen, L., Ostrem, M., & Horsburgh, C. R. (2008). Use of a population-based survey to describe the health of Boston public housing residents. American Journal of Public Health, 98(1), 85–91.  https://doi.org/10.2105/AJPH.2006.094912.PubMedPubMedCentralCrossRefGoogle Scholar
  18. Distasio, J. & McCullough, S. (2014). Holding on!: supporting successful tenancies for the hard to house. Retrieved from http://homelesshub.ca/sites/default/files/2014 Successful Tenancies - FINAL.pdf. Accessed 29 September 2018
  19. Dockery, A. M., Ong, R., Whelan, S., & Wood, G. (2008). The relationship between public housing wait lists, public housing tenure and labour market outcomes. Melbourne.Google Scholar
  20. Duchon, L. M., Weitzman, B., & Shinn, M. (1999). The relationship of residential instability to medical care utilization among poor mothers in New York City. Medical Care, 37(12), 1282–1293.PubMedCrossRefGoogle Scholar
  21. Fertig, A., & Reingold, D. (2007). Public housing, health, and health behaviors: is there a connection? Journal of Policy Analysis and Management, 26(4), 831–859.  https://doi.org/10.1002/pam.PubMedCrossRefGoogle Scholar
  22. Finlayson, G., Smith, M., Burchill, C., Towns, D., Peeler, W., Soodeen, R.-A. A., … Guenette, W. (2013). Social housing in Manitoba part I: Manitoba social housing data. Winnipeg, MB.Google Scholar
  23. Gelberg, L., Andersen, R. M., & Leake, B. D. (2000). The behavioral model for vulnerable populations: application to medical care use and outcomes for homeless people. Health Services Research, 34(6), 1273–1302.PubMedPubMedCentralGoogle Scholar
  24. Government Assisted Housing. (n.d.). Retrieved from http://www.cmhc-schl.gc.ca/en/co/buho/seca/seca_001.cfm. Accessed 11 January 2014
  25. Hanley, G. E., & Morgan, S. (2008). On the validity of area-based income measures to proxy household income. BMC Health Services Research, 8, 1–7.  https://doi.org/10.1186/1472-6963-8-79.CrossRefGoogle Scholar
  26. Heaman, M., Kingston, D., Helewa, M. E., Brownell, M., Derksen, S., Bogdanovic, B., … Bailly, A. (2012). Perinatal services and outcomes in Manitoba. Winnipeg, MB.Google Scholar
  27. Hinds, A. M., Bechtel, B., Distasio, J., Roos, L. L., & Lix, L. M. (2016). Health and social predictors of applications to public housing: a population-based analysis. Journal of Epidemiology and Community Health, 70(12), 1229–1235.  https://doi.org/10.1136/jech-2015-206845.PubMedCrossRefGoogle Scholar
  28. Hinds, A. M., Bechtel, B., Distasio, J., Roos, L. L., & Lix, L. M. (2018). Changes in healthcare use among individuals who move into public housing: a population-based investigation. BMC Health Services Research, 18, 411.  https://doi.org/10.1186/s12913-018-3109-7.PubMedPubMedCentralCrossRefGoogle Scholar
  29. Iron, K., & Goel, V. (1998). Sex differences in the factors related to hospital utilization: results from the 1990 Ontario Health Survey. Journal of Women’s Health, 7(3), 359–369.PubMedCrossRefGoogle Scholar
  30. Kushel, M. B., Perry, S., Bangsberg, D., Clark, R., & Moss, A. R. (2002). Emergency department use among the homeless and marginally housed: results from a community-based study. American Journal of Public Health, 92(5), 778–784.PubMedPubMedCentralCrossRefGoogle Scholar
  31. Latimer, E. A., Rabouin, D., Cao, Z., Ly, A., Powell, G., Aubry, T., … Goering, P. N. (2017). Costs of services for homeless people with mental illness in 5 Canadian cities: a large prospective follow-up study. CMAJ Open, 5(3), E576–E585.  https://doi.org/10.9778/cmajo.20170018.
  32. Lix, L. M., Yao, X., Kephart, G., Quan, H., Smith, M., Kuwornu, J. P., … Sikdar, K. (2015). A prediction model to estimate completeness of electronic physician claims databases. BMJ Open, 5(8), e006858.  https://doi.org/10.1136/bmjopen-2014-006858.
  33. Lix, L. M., Kuwornu, J. P., Kroeker, K., Kephart, G., Sikdar, K. C., Smith, M., & Quan, H. (2016). Estimating the completeness of physician billing claims for diabetes case ascertainment using population-based prescription drug data. Health Promotion and Chronic Disease Prevention in Canada: Research, Policy and Practice, 36(3), 54–60.CrossRefGoogle Scholar
  34. Mackenzie, C. S., Gekoski, W. L., & Knox, V. J. (2006). Age, gender, and the underutilization of mental health services: the influence of help-seeking attitudes. Aging and Mental Health, 10(6), 574–582.  https://doi.org/10.1080/13607860600641200.PubMedCrossRefGoogle Scholar
  35. Marra, C. A., Lynd, L. D., Harvard, S. S., & Grubisic, M. (2011). Agreement between aggregate and individual-level measures of income and education: a comparison across three patient groups. BMC Health Services Research, 11, 1–7.  https://doi.org/10.1186/1472-6963-11-69.CrossRefGoogle Scholar
  36. O’Toole, T. P., Gibbon, J. L., Hanusa, B. H., & Fine, M. J. (1999). Utilization of health care services among subgroups of urban homeless and housed poor. Journal of Health Politics, Policy and Law, 24(1), 91–114.PubMedCrossRefGoogle Scholar
  37. Roos, L. L., Walld, R., & Witt, J. (2014). Adolescent outcomes and opportunities in a Canadian province: looking at siblings and neighbors. BMC Public Health, 14(1), 1–16.  https://doi.org/10.1186/1471-2458-14-506.CrossRefGoogle Scholar
  38. Sanbonmatsu, L., Ludwig, J., Katz, L. F., Gennetian, L., Duncan, G., Kessler, R., … Tessler Lindau, S. (2011). Moving to opportunity for fair housing demonstration program: final impacts evaluation. Retrieved from https://www.huduser.gov/publications/pdf/mtofhd_fullreport_v2.pdf. Accessed 15 August 2018
  39. SAS Institute Inc. (2013). The GENMOD procedure. In SAS/STAT 9.2 User’s Guide (pp. 2871–3076). Cary, NC: SAS Institute Inc.Google Scholar
  40. Sibley, L. M., Moineddin, R., Agha, M. M., & Glazier, R. H. (2010). Risk adjustment using administrative data-based and survey-derived methods for explaining physician utilization. Medical Care, 48(2), 175–182.  https://doi.org/10.1097/MLR.0b013e3181c16102.PubMedCrossRefGoogle Scholar
  41. Simning, A., Van Wijngaarden, E., & Conwell, Y. (2011). Anxiety, mood, and substance use disorders in United States African-American public housing residents. Social Psychiatry and Psychiatric Epidemiology, 46(10), 983–992.  https://doi.org/10.1007/s00127-010-0267-2.PubMedCrossRefGoogle Scholar
  42. Smith, S. J., Alexander, A., & Easterlow, D. (1997). Rehousing as a health intervention: miracle or mirage? Health and Place, 3(4), 203–216.  https://doi.org/10.1016/S1353-8292(97)00015-4.CrossRefGoogle Scholar
  43. Smith, M., Finlayson, G., Martens, P., Dunn, J., Prior, H., Taylor, C., … Hinds, A. (2013). Social housing in Manitoba part II: social housing and health in Manitoba: a first look. Winnipeg, MB. Retrieved from http://mchp-appserv.cpe.umanitoba.ca/reference/housing_web_version_final.pdf. Accessed 13 January 2014
  44. Soobader, M. J., LeClere, F. B., Hadden, W., & Maury, B. (2001). Using aggregate geographic data to proxy individual socioeconomic status: does size matter? American Journal of Public Health, 91(4), 632–636.  https://doi.org/10.2105/AJPH.91.4.632.PubMedPubMedCentralCrossRefGoogle Scholar
  45. Srebnik, D., Connor, T., & Sylla, L. (2013). A pilot study of the impact of housing first-supported housing for intensive users of medical hospitalization and sobering services. American Journal of Public Health, 103(2), 316–321.  https://doi.org/10.2105/AJPH.2012.300867.PubMedPubMedCentralCrossRefGoogle Scholar
  46. Tsemberis, S., & Eisenberg, R. F. (2000). Pathways to housing: supported housing for street-dwelling homeless individuals with psychiatric disabilities. Psychiatric Services, 51(4), 487–493.  https://doi.org/10.1176/appi.ps.51.4.487.PubMedCrossRefGoogle Scholar
  47. Tsemberis, S., Gulcur, L., & Nakae, M. (2004). Housing first, consumer choice and harm reduction for homeless individuals. American Journal of Public Health, 94(4), 651–656.  https://doi.org/10.2105/AJPH.94.4.651.PubMedPubMedCentralCrossRefGoogle Scholar
  48. Watson, D. E., Katz, A., Reid, R. J., Bogdanovic, B., Roos, N., & Heppner, P. (2004). Family physician workloads and access to care in Winnipeg: 1991 to 2001. Canadian Medical Association Journal, 171(4), 339–342.PubMedCrossRefGoogle Scholar
  49. Wiggers, J., Radvan, D., Clover, K., Hazell, T., Alexander, J., & Considine, R. (2001). Public housing, public health: health needs of public housing tenants. Australian and New Zealand Journal of Public Health, 25(2), 111–114.  https://doi.org/10.1111/j.1753-6405.2001.tb01830.x.PubMedCrossRefGoogle Scholar
  50. Wood, L., Flatau, P., Zaretzky, K., Foster, S., Vallesi, S., & Miscenko, D. (2016). What are the health, social and economic benefits of providing public housing and support to formerly homeless people? Melbourne. Retrieved from http://www.ahuri.edu.au/research/final-reports/265. Accessed 28 December 2017

Copyright information

© The Canadian Public Health Association 2018

Authors and Affiliations

  1. 1.Department of Community Health SciencesUniversity of ManitobaWinnipegCanada
  2. 2.Cross Ministry and Community Partnership Initiatives, Community and Social ServicesEdmontonCanada
  3. 3.Department of GeographyUniversity of WinnipegWinnipegCanada

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