Division of HIV/AIDS, San Francisco General Hospital, University of California, San Francisco (UCSF), POB 0874, UCSF, San Francisco, CA 94143, USA.
J Gen Intern Med. 2013 Jan;28(1):91-8. doi: 10.1007/s11606-012-2176-4. Epub 2012 Aug 18.
Food insecurity, or the uncertain availability of nutritionally adequate, safe foods, has been associated with poor HIV outcomes. There are few data on the extent to which food insecurity impacts patterns of health-care utilization among HIV-infected individuals.
We examined whether food insecurity was associated with hospitalizations, Emergency Department (ED) visits, and non-ED outpatient visits.
HIV-infected, homeless and marginally housed individuals participating in the San Francisco Research on Access to Care in the Homeless (REACH) cohort underwent quarterly structured interviews and blood draws. We measured food insecurity with the validated Household Food Insecurity Access Scale, and categorized participants as food secure, mild/moderately food insecure, and severely food insecure. Primary outcomes were: (1) any hospitalizations, (2) any ED visits, and (3) any non-ED outpatient visits. Generalized estimating equations were used to estimate model parameters, adjusting for socio-demographic (age, sex, ethnicity, education, income, housing status, health insurance) and clinical variables (CD4 nadir, time on antiretroviral therapy, depression, and illicit drug use).
Beginning in November 2007, 347 persons were followed for a median of 2 years. Fifty-six percent of participants were food insecure at enrollment. Compared with food-secure persons, those with severe food insecurity had increased odds of hospitalizations [adjusted odds ratio (AOR) = 2.16, 95 % confidence interval (CI) = 1.50-3.09] and ED visits (AOR = 1.71, 95 % CI = 1.06-2.30). While the odds of an outpatient visit were 41 % higher for severely food insecure individuals, the effect was not statistically significant (AOR = 1.41, 95 % CI = 0.99-2.01). Mild/moderate food insecurity was also associated with increased hospitalizations (AOR = 1.56, 95 % CI = 1.06-2.30), ED visits (AOR = 1.57, 95 % CI = 1.22-2.03), and outpatient visits (AOR = 1.68, 95 % CI = 1.20-2.17).
Food insecurity is associated with increased health services utilization among homeless and marginally housed HIV-infected individuals in San Francisco. Increased ED visits and hospitalizations are not related to fewer ambulatory care visits among food-insecure individuals. Addressing food insecurity should be a critical component of HIV treatment programs and may reduce reliance on acute care utilization.
食品不安全，即无法稳定获得营养充足且安全的食物，与 HIV 不良结局相关。关于食品不安全对 HIV 感染者卫生保健利用模式的影响程度，数据很少。
我们检验食品不安全是否与住院、急诊就诊和非急诊门诊就诊相关。
参与旧金山无家可归者卫生保健获取研究（REACH）队列的 HIV 感染者、无家可归者和住房不稳定者每季度接受一次结构化访谈和血液采集。我们使用经验证的家庭食品不安全评估量表测量食品不安全程度，并将参与者分为食品安全、轻度/中度食品不安全和重度食品不安全。主要结局为：（1）任何住院治疗，（2）任何急诊就诊，（3）任何非急诊门诊就诊。采用广义估计方程估计模型参数，调整了社会人口统计学（年龄、性别、种族、教育、收入、住房状况、医疗保险）和临床变量（CD4 最低点、抗逆转录病毒治疗时间、抑郁和非法药物使用）。
从 2007 年 11 月开始，347 人随访中位时间为 2 年。56%的参与者入组时存在食品不安全。与食品安全者相比，严重食品不安全者住院治疗的可能性更高[校正比值比（AOR）=2.16，95%置信区间（CI）=1.50-3.09]和急诊就诊（AOR=1.71，95%CI=1.06-2.30）。严重食品不安全者门诊就诊的可能性高 41%，但差异无统计学意义（AOR=1.41，95%CI=0.99-2.01）。轻度/中度食品不安全也与住院治疗（AOR=1.56，95%CI=1.06-2.30）、急诊就诊（AOR=1.57，95%CI=1.22-2.03）和门诊就诊（AOR=1.68，95%CI=1.20-2.17）增加相关。
在旧金山无家可归和住房不稳定的 HIV 感染者中，食品不安全与卫生保健服务利用率增加相关。急诊就诊和住院治疗的增加与食品不安全者门诊就诊次数减少无关。解决食品不安全问题应该是 HIV 治疗计划的关键组成部分，这可能会减少对急性护理的依赖。
