Rising inability to obtain needed health care among homeless persons in Birmingham, Alabama (1995-2005).
BACKGROUND
Homeless persons depend disproportionately on the health-care safety net for medical services. National reports identify financial strains to this safety net. Whether this has affected homeless persons is unknown.


OBJECTIVE
We quantified changes in the proportion of homeless persons reporting unmet need for health care in Birmingham, Alabama, comparing two periods, 1995 and 2005. We assessed whether a period effect was independent of characteristics of persons surveyed.


METHODS
Analysis of two surveys conducted with identical methods among representative samples of homeless persons in 1995 (n = 161) and 2005 (n = 161).


METHODS
Report of unmet need (inability to obtain care when needed) was the dependent variable. Two survey periods (1995 and 2005) were compared, with multivariable adjustment for sociodemographic and health characteristics. Reasons for unmet need were determined among the subset of persons reporting unmet need.


RESULTS
Unmet need for health care was more common in 2005 (54%) than in 1995 (32%) (p < 0.0001), especially for non-Blacks (64%) and females (65%). Adjusting for individual characteristics, a survey year of 2005 independently predicted unmet need (odds ratio 2.68, 95% CI 1.49-4.83). Among persons reporting unmet need (87 of 161 in 2005; 52 of 161 in 1995), financial barriers were more commonly cited in 2005 (67% of 87) than in 1995 (42% of 52) (p = 0.01).


CONCLUSIONS
A rise in unmet health-care needs was reported among Birmingham's homeless from 1995 to 2005. This period effect was independent of population characteristics and may implicate a local safety net inadequacy. Additional data are needed to determine if this represents a national trend.
Center for Surgical, Medical Acute care Research and Transitions, Birmingham Veterans Affairs Medical Center and Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, USA. skertesz@uab.edu
Stefan G
SG
Kertesz
Stephen W
SW
Hwang
Jay
J
Irwin
Ferris J
FJ
Ritchey
Mark E
ME
Lagory
D000407:Alabama; D016001:Confidence Intervals; D003625:Data Collection; D006297:Health Services Accessibility / Q000266:history / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand / Q000266:history / Q000706:statistics & numerical data*; D049673:History, 20th Century; D049674:History, 21st Century; D006703:Ill-Housed Persons / Q000266:history / Q000706:statistics & numerical data*; D006801:Humans; D008507:Medically Underserved Area; D015999:Multivariate Analysis; D016017:Odds Ratio; D012044:Regression Analysis