title: Residential Stability Reduces Unmet Health Care Needs and Emergency Department Utilization among a Cohort of Homeless and Vulnerably Housed Persons in Canada.
abstract: This study examined the association of housing status over time with unmet physical health care needs and emergency department utilization among homeless and vulnerably housed persons in Canada. Homeless and vulnerably housed individuals completed interviewer-administered surveys on housing, unmet physical health care needs, health care utilization, sociodemographic characteristics, substance use, and health conditions at baseline and annually for 4 years. Generalized logistic mixed effects regression models examined the association of residential stability with unmet physical health care needs and emergency department utilization, adjusting for potential confounders. Participants were from Vancouver (n = 387), Toronto (n = 390), and Ottawa (n = 396). Residential stability was associated with lower odds of having unmet physical health needs (adjusted odds ratio (AOR), 0.82; 95 % confidence interval (CI), 0.67, 0.98) and emergency department utilization (AOR, 0.74; 95 % CI, 0.62, 0.88) over the 4-year follow-up period, after adjusting for potential confounders. Residential stability is associated with fewer unmet physical health care needs and lower emergency department utilization among homeless and vulnerably housed individuals. These findings highlight the need to address access to stable housing as a significant determinant of health disparities.
authors.affiliation: Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Denise
authors.initials: D
authors.lastname: Jaworsky
authors.affiliation: Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, 588-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
authors.forename: Anne
authors.initials: A
authors.lastname: Gadermann
authors.affiliation: Université de Montréal, Montréal, QC, Canada.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Duhoux
authors.affiliation: Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Trudy E
authors.initials: TE
authors.lastname: Naismith
authors.affiliation: Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, 588-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
authors.forename: Monica
authors.initials: M
authors.lastname: Norena
authors.affiliation: Centre for Research in Inner City Health, St. Michael's Hospital, Toronto, ON, Canada.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: To
authors.affiliation: Centre for Research in Inner City Health, St. Michael's Hospital, Toronto, ON, Canada.|Department of Medicine, University of Toronto, Toronto, ON, Canada.
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Hwang
authors.affiliation: Department of Medicine, University of British Columbia, Vancouver, BC, Canada. apalepu@hivnet.ubc.ca.|Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, 588-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada. apalepu@hivnet.ubc.ca.
authors.forename: Anita
authors.initials: A
authors.lastname: Palepu
mesh_terms: D000328:Adult; D002170:Canada; D015331:Cohort Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006301:Health Services Needs and Demand; D006703:Ill-Housed Persons; D006798:Housing; D006801:Humans; D008297:Male; D008875:Middle Aged; D011795:Surveys and Questionnaires
keywords: Emergency department utilization; Homeless; Housing