• Patricia Martin, Winston Liaw, Andrew Bazemore, Anuradha Jetty, Stephen Petterson, and Margot Kushel.
• From Unity Health Care, Washington, D.C. (PM); Department of Health Systems and Population Health Sciences, University of Houston College of Medicine, Houston (WL); Robert Graham Center: Policy Studies in Family Medicine and Primary Care, Washington D.C. (AB, AJ, SP); Center for Vulnerable Populations, University of California, San Francisco/Zuckerberg San Francisco General, San Francisco (MK). pmartin@unityhealthcare.org.
• J Am Board Fam Med. 2019 Jul 1; 32 (4): 521-530.

ObjectiveHousing insecurity has been linked to high-risk behaviors and chronic disease, although less is known about the pathways leading to poor health. We sought to determine whether housing insecurity is associated with access to preventive and primary care.MethodsWe conducted weighted univariate, bivariate, and multivariate analyses by using 2011 to 2015 Behavioral Risk factor Surveillance Survey data (N = 228,131 adults). The independent variable was housing insecurity derived from the question on worry about paying rent or mortgage. The outcome measures were health services utilization (no usual source of care, no routine checkup in the past 1 year, and delayed medical care due to cost), self-rated health (number of days reported physical, mental health not good, and poor overall health), and number of chronic diseases (0, 1, 2 or more). The covariates included age, sex, race/ethnicity, income, level of education, marital status, and number of children in the family. We also adjusted for state fixed effects and survey year. We performed χ2 tests and binary logistic regressions on categorical variables and ran t tests and estimated linear regression models on continuous variables. Multinomial logistic regressions were estimated for the number of chronic diseases.ResultsOf the 228,131 adults in the study sample, 28,704 adults reported housing insecurity. We found that those with housing insecurity were more likely to forgo routine check-ups and lack usual sources of care. Low-income individuals, minorities, the unmarried, and middle-aged adults were more likely to report housing insecurity.ConclusionHousing insecurity is associated with worse access to preventive and primary care. Interventions to enhance access for these patients should be developed and studied.© Copyright 2019 by the American Board of Family Medicine.

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