Jaworsky Denise, Gadermann Anne, Duhoux Arnaud, Naismith Trudy E, Norena Monica, To Matthew J, Hwang Stephen W, Palepu Anita
Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, 588-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
J Urban Health. 2016 Aug;93(4):666-81. doi: 10.1007/s11524-016-0065-6.
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.
本研究考察了加拿大无家可归者和住房条件差的人群中,长期住房状况与未满足的身体健康护理需求以及急诊科就诊率之间的关联。无家可归者和住房条件差的个体在基线时以及之后连续4年每年完成由访谈员进行的关于住房、未满足的身体健康护理需求、医疗保健利用情况、社会人口学特征、物质使用情况和健康状况的调查。广义逻辑混合效应回归模型考察了居住稳定性与未满足的身体健康护理需求以及急诊科就诊率之间的关联,并对潜在混杂因素进行了调整。参与者来自温哥华(n = 387)、多伦多(n = 390)和渥太华(n = 396)。在对潜在混杂因素进行调整后,在4年的随访期内,居住稳定性与未满足身体健康需求的较低几率(调整后的优势比(AOR)为0.82;95%置信区间(CI)为0.67,0.98)以及急诊科就诊率(AOR为0.74;95%CI为0.62,0.88)相关。居住稳定性与无家可归者和住房条件差的个体中未满足的身体健康护理需求减少以及急诊科就诊率降低相关。这些发现凸显了解决稳定住房问题作为健康差距重要决定因素的必要性。