Division of General Internal Medicine, Department of Medicine, McGill University, Montreal, Canada.
Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, Canada.
Int J Public Health. 2019 Apr;64(3):399-409. doi: 10.1007/s00038-018-1167-6. Epub 2018 Oct 31.
To determine the relationship between housing instability, as measured by the number of residential moves, with problematic substance use, unmet healthcare needs, and acute care utilization.
A cohort of homeless or vulnerably housed persons from Vancouver (n = 387), Toronto (n = 390), and Ottawa (n = 396) completed interviewer-administered surveys at baseline and annually for 4 years from 2009 to 2013. Generalized mixed effects logistic regression models were used to examine the association between the number of residential moves and each of the three outcome variables, adjusting for potential confounders.
The number of residential moves was significantly associated with higher acute care utilization [adjusted odds ratio (AOR) 1.25; 95% confidence interval (CI) CI: 1.17-1.33], unmet healthcare needs (AOR 1.14; 95% CI: 1.07-1.22), and problematic substance use (AOR 1.26; 95% CI: 1.16-1.36). Having chronic physical or mental conditions and recent incarceration were also found to be associated with the outcomes.
Housing instability increased the odds of all three poor health metrics, highlighting the importance of stable housing as a critical social determinant of health.
确定住房不稳定性（以居住地变动次数衡量）与不良物质使用、未满足的医疗保健需求和急性护理利用之间的关系。
2009 年至 2013 年期间，来自温哥华（n=387）、多伦多（n=390）和渥太华（n=396）的无家可归或住房不稳定者参加了一项队列研究，在基线和每年进行一次访谈者管理的调查。使用广义混合效应逻辑回归模型，调整潜在混杂因素后，检验居住地变动次数与三个结局变量中的每一个之间的关联。
居住地变动次数与更高的急性护理利用率显著相关（调整后的优势比 [AOR] 1.25；95%置信区间 [CI]：1.17-1.33）、未满足的医疗保健需求（AOR 1.14；95% CI：1.07-1.22）和不良物质使用（AOR 1.26；95% CI：1.16-1.36）。患有慢性身体或精神疾病和最近被监禁也与这些结果有关。
住房不稳定性增加了所有三种不良健康指标的几率，突出了稳定住房作为健康的重要社会决定因素的重要性。
