title: Housing instability and food insecurity as barriers to health care among low-income Americans.
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.
  
  
  METHODS
  Secondary data analysis of the National Survey of American Families.
  
  
  METHODS
  16,651 low-income adults.
  
  
  METHODS
  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.
authors.affiliation: Division of General Internal Medicine, UCSF/San Francisco General Hospital, San Francisco, CA 94143, USA. mkushel@medsfgh.ucsf.edu
authors.forename: Margot B
authors.initials: MB
authors.lastname: Kushel
authors.forename: Reena
authors.initials: R
authors.lastname: Gupta
authors.forename: Lauren
authors.initials: L
authors.lastname: Gee
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Haas
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005523:Food Supply; D006296:Health Services / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000191:economics*; D006703:Ill-Housed Persons / Q000706:statistics & numerical data*; D006798:Housing / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D006815:Hunger; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011203:Poverty / Q000208:ethnology; D012959:Socioeconomic Factors