• Margot B Kushel, Reena Gupta, Lauren Gee, and Jennifer S Haas.
• Division of General Internal Medicine, UCSF/San Francisco General Hospital, San Francisco, CA 94143, USA. mkushel@medsfgh.ucsf.edu
• J Gen Intern Med. 2006 Jan 1; 21 (1): 717771-7.

BackgroundHomelessness and hunger are associated with poor health outcomes. Housing instability and food insecurity describe less severe problems securing housing and food.ObjectiveTo determine the association between housing instability and food insecurity and access to ambulatory health care and rates of acute health care utilization.DesignSecondary data analysis of the National Survey of American Families.Participants16,651 low-income adults.MeasurementSelf-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.Results23.6% 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).ConclusionsHousing 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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