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

  • Population Health Intervention Research
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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.

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.

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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

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.

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Authors and Affiliations

  1. Department of Community Health Sciences, University of Manitoba, S113-750 Bannatyne Ave, Winnipeg, Manitoba, R3E 0W3, Canada

    Aynslie M. Hinds, Leslie L. Roos & Lisa M. Lix

  2. Cross Ministry and Community Partnership Initiatives, Community and Social Services, 3rd floor, 10044-108 Street, Edmonton, Alberta, T5J 5E6, Canada

    Brian Bechtel

  3. Department of Geography, University of Winnipeg, 515 Portage Avenue, Winnipeg, Manitoba, R3B 2E9, Canada

    Jino Distasio

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  1. Aynslie M. Hinds
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  2. Brian Bechtel
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  4. Leslie L. Roos
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Correspondence to Aynslie M. Hinds.

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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.

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

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Hinds, A.M., Bechtel, B., Distasio, J. et al. Public housing and healthcare use: an investigation using linked administrative data. Can J Public Health 110, 127–138 (2019). https://doi.org/10.17269/s41997-018-0162-2

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