Gordon Adam J, Haas Gretchen L, Luther James F, Hilton Michael T, Goldstein Gerald
Mental Illness Research, Education, and Clinical Center and Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, and University of Pittsburgh School of Medicine.
Psychol Serv. 2010 May;7(2):65-74. doi: 10.1037/a0018479.
This study assessed differences in personal, medical, and health care utilization characteristics of homeless veterans living in metropolitan versus nonmetropolitan environments. Data were obtained from a Veterans Health Administration (VHA) network sample of homeless veterans. Chi-square tests were used to assess differences in demographics, military history, living situation, medical history, employment status, and health care utilization. Moderator analyses determined whether predictors of health care utilization varied by metropolitan status. Of 3,595 respondents, 60% were residing in metropolitan areas. Age, sex, and marital status were similar between metropolitan and nonmetropolitan homeless. Metropolitan homeless were less likely to receive public financial support or to be employed, to have at least one medical problem, one psychiatric problem, or current alcohol dependency, but more likely to be homeless longer. Of the 52% of the sample who used VHA care in the last 6 months, 53% were metropolitan versus 49% nonmetropolitan (p = .01). Metropolitan status predicted at least one VHA visit within the prior 6 months (OR:1.3, CI:1.1, 1.6). Significant differences occur in the personal, medical, and health care utilization characteristics of homeless veterans in metropolitan versus nonmetropolitan areas.
本研究评估了生活在大都市和非大都市环境中的无家可归退伍军人在个人、医疗及医疗保健利用特征方面的差异。数据取自退伍军人健康管理局（VHA）的无家可归退伍军人网络样本。卡方检验用于评估人口统计学、军事史、生活状况、病史、就业状况及医疗保健利用方面的差异。调节变量分析确定了医疗保健利用的预测因素是否因大都市状况而异。在3595名受访者中，60%居住在大都市地区。大都市和非大都市的无家可归者在年龄、性别和婚姻状况方面相似。大都市的无家可归者获得公共财政支持或就业的可能性较小，有至少一种医疗问题、一种精神问题或当前酒精依赖的可能性较小，但无家可归时间更长的可能性较大。在过去6个月中使用VHA护理的样本中，52%为大都市地区的人，其中53%使用了VHA护理，而非大都市地区的这一比例为49%（p = 0.01）。大都市状况预测了在过去6个月内至少有一次VHA就诊（比值比：1.3，置信区间：1.1，1.6）。大都市和非大都市地区的无家可归退伍军人在个人、医疗及医疗保健利用特征方面存在显著差异。
