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Research ArticleOriginal Research

Adults with Housing Insecurity Have Worse Access to Primary and Preventive Care

Patricia Martin, Winston Liaw, Andrew Bazemore, Anuradha Jetty, Stephen Petterson and Margot Kushel
The Journal of the American Board of Family Medicine July 2019, 32 (4) 521-530; DOI: https://doi.org/10.3122/jabfm.2019.04.180374
Patricia Martin
From Unity Health Care, Washington, D.C. (PM); Department of Health Systems and Population Health Sciences, University of Houston College of Medicine, Houston (WL); Robert Graham Center: Policy Studies in Family Medicine and Primary Care, Washington D.C. (AB, AJ, SP); Center for Vulnerable Populations, University of California, San Francisco/Zuckerberg San Francisco General, San Francisco (MK).
DO
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Winston Liaw
From Unity Health Care, Washington, D.C. (PM); Department of Health Systems and Population Health Sciences, University of Houston College of Medicine, Houston (WL); Robert Graham Center: Policy Studies in Family Medicine and Primary Care, Washington D.C. (AB, AJ, SP); Center for Vulnerable Populations, University of California, San Francisco/Zuckerberg San Francisco General, San Francisco (MK).
MD, MPH
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Andrew Bazemore
From Unity Health Care, Washington, D.C. (PM); Department of Health Systems and Population Health Sciences, University of Houston College of Medicine, Houston (WL); Robert Graham Center: Policy Studies in Family Medicine and Primary Care, Washington D.C. (AB, AJ, SP); Center for Vulnerable Populations, University of California, San Francisco/Zuckerberg San Francisco General, San Francisco (MK).
MD, MPH
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Anuradha Jetty
From Unity Health Care, Washington, D.C. (PM); Department of Health Systems and Population Health Sciences, University of Houston College of Medicine, Houston (WL); Robert Graham Center: Policy Studies in Family Medicine and Primary Care, Washington D.C. (AB, AJ, SP); Center for Vulnerable Populations, University of California, San Francisco/Zuckerberg San Francisco General, San Francisco (MK).
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Stephen Petterson
From Unity Health Care, Washington, D.C. (PM); Department of Health Systems and Population Health Sciences, University of Houston College of Medicine, Houston (WL); Robert Graham Center: Policy Studies in Family Medicine and Primary Care, Washington D.C. (AB, AJ, SP); Center for Vulnerable Populations, University of California, San Francisco/Zuckerberg San Francisco General, San Francisco (MK).
PhD
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Margot Kushel
From Unity Health Care, Washington, D.C. (PM); Department of Health Systems and Population Health Sciences, University of Houston College of Medicine, Houston (WL); Robert Graham Center: Policy Studies in Family Medicine and Primary Care, Washington D.C. (AB, AJ, SP); Center for Vulnerable Populations, University of California, San Francisco/Zuckerberg San Francisco General, San Francisco (MK).
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Article Figures & Data

Tables

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    Table 1.

    Health Outcomes and Utilization by Housing Insecurity

    Self-Reported Health Status and UtilizationWorry About Paying Rent or Mortgage
    Yes (n = 28,704)No (n = 199,427)P Value
    n%n%
    Number of Chronic Conditions
        091030.810,98443.5<.001
        191927.78,62026.6397
        2 or more1,97341.512,31230.4<.001
    Health services utilization
        Deferred care due to cost11,00942.814,89910.2<.001
        Had a routine check-up within past year18,82164.0148,76873.8<.001
        No usual source of care6,16829.026,68219.4<.001
    Self-reported health (mean number of days in last month)
        Poor physical health8.63.9<.001
        Poor mental health9.52.6<.001
        Poor overall health8.03.3<.001
    • Source: Author analysis of 2011 to 2015 Behavioral Risk Factor Surveillance Survey (BRFSS) data. Between 2011 to 2015, 23 states implemented the Social Context Module that included this question. BRFSS asks about self-reported health by determining the responses to three questions that inquire about the specific number of days within the past month that physical, mental, and overall health were not good.

    • View popup
    Supplemental Table 1.

    Demographic Characteristics of Respondents, in and Not in Sample

    CharacteristicWorry About Paying Rent or Mortgage
    In sample (n = 228,131)Not in sample (n = 2,151,916)P Value
    N%N%
    Sex
        Male91,36247.7880,37048.7.2232
        Female136,76952.3127154651.3<.001
    Age
        18–24 years8,6769.8114,87413.2<.001
        25–34 years21,20715.9212,68817.5<.001
        35–44 years28,77617.6262,63916.7<.001
        45–54 years40,46519.4368,74117.9<.001
        55–64 years52,99217.8482,44316.1<.001
        65 and over76,01519.5710,53118.6<.001
    Education
        Less than 12 years18,41514.1183,75314.9<.001
        Completed 12 years64,80128.9621,59228.4.0188
        Some college or technical school (<3 years)62,42630.9582,44330.4.0143
        College (4 years or more)82,09926.1752,85525.6<.001
    Income
        Less than 15k20,6929.4220,64911.3<.001
        Greater than 15k and less than 25k34,11715.9323,62515.3<.001
        Greater than 25 - less than 50k52,04222.547479521.0<.001
        Greater than 50k91,17939.4800,33637.3<.001
    Race
        Non-Hispanic white174,98568.91,648,54763.0<.001
        Non-Hispanic black26,23917.2163,02510.9<.001
        Non-Hispanic other13,0765.4134,5937.7<.001
        Hispanic11,2687.5172,00716.8<.001
    Marital status
        Married124,47255.11,125,37550.0<.001
        Divorced31,60011.1299,00810.6<.001
        Widowed30,7197.1286,4316.8<.001
        Separated4,7812.545,4662.6<.001
        Never married30,71820.3322,39524.6<.001
        Unmarried, with partner5,0493.657,9214.7<.001
    Number of children
        0166,87663.01,570,58362.1<.001
        124,29315.1231,47415.3.2636
        221,93113.2204,95913.2.829
        39,4385.687,0575.7.2745
        4 or more4,9092.845,1443.0.1448
    Family size
        160,64113.6558,28312.7<.001
        275,66327.8709,38425.2<.001
        323,95713.8234,10013.7.4744
        420,56412.9198,82813.2.0341
        59,7426.394,8706.9<.001
        6 or more6,1394.463,0505.4<.001
    Reported health status
        Excellent39,00817.7377,21319.0<.001
        Very good75,26632.4693,44531.5<.001
        Good70,19431.3660,92631.2.4132
        Fair30,35413.3291,98713.2.4565
        Poor12,7665.0120,3944.8.0016
        Missing5430.37,9510.4
    Number of chronic conditions
        082,84641.5821,66243.0<.001
        163,80126.3601,23025.8<.001
        2 or more75,06432.2661,78331.2<.001
        High cost25,90815.3250,50715.4<.001
        Routine check-up167,58972.31,558,54769.4<.001
        No USC32,85020.9324,19322.6<.001
    • Source: Author analysis of 2011 to 2015 Behavioral Risk Factor Surveillance Survey (BRFSS). Between 2011 to 2015, 23 states implemented the Social Context Module that included this question.

    • View popup
    Supplemental Table 2.

    Demographic Characteristics of Respondents by Housing Insecurity

    CharacteristicWorry About Paying Rent or Mortgage
    Yes (n = 28,704)No (n = 199,427)P Value
    n%n%
    Sex
        Male9,99642.781,36648.6<.001
        Female18,70857.3118,06151.4
    Age
        18–24 years1,43510.47,2419.7<.1346
        25–34 years3,62218.917,58515.4<.001
        35–44 years4,89121.323,88516.9<.001
        45–54 years6,84523.433,62018.7<.001
        55–64 years6,86816.646,12418.0<.001
        65 and over5,0439.570,97221.3<.001
    Education
        Less than 12 years4,42324.013,99212.2<.001
        Completed 12 years9,98332.654,81828.2<.001
        Some college or technical school (<3 years)8,70031.153,72630.8.6321
        College (4 years or more)5,54312.176,55628.6<.001
    Income
        Less than 15k7,19723.913,4956.7<.001
        Greater than 15k and less than 25k7,81728.026,30013.7<.001
        Greater than 25k and less than 50k6,26221.145,78022.7<.001
        Greater than 50k4,24015.186,93943.8<.001
    Race
        Non-Hispanic white19,07161.6155,91470.2<.001
        Non-Hispanic black4,97222.521,26716.3<.001
        Non-Hispanic other2,2286.010,8485.3.0043
        Hispanic2,0599.09,2097.2<.001
    Marital status
        Married11,10640.3113,36657.8<.001
        Divorced6,57617.425,0249.9<.001
        Widowed3,0416.027,6787.4<.001
        Separated1,5495.73,2321.9<.001
        Never married5,33425.225,38419.4<.001
        Unmarried, with partner9855.04,0643.4<.001
    Number of children
        018,24155.1148,63564.4<.001
        14,29318.620,00014.5<.001
        23,51115.418,42012.8<.001
        31,6016.87,8375.3<.001
        4 or more9693.83,9402.7<.001
    Reported health status
        Excellent2,2788.736,73019.3<.001
        Very good5,67520.469,59134.7<.001
        Good9,10032.861,09431.1<.001
        Fair7,04224.223,31211.3<.001
        Poor4,49013.58,2763.5<.001
    • Source: Author analysis of 2011 to 2015 BRFSS. Between 2011 and 2015, 23 states implemented the Social Context Module that included this question.

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The Journal of the American Board of Family     Medicine: 32 (4)
The Journal of the American Board of Family Medicine
Vol. 32, Issue 4
July-August 2019
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Adults with Housing Insecurity Have Worse Access to Primary and Preventive Care
Patricia Martin, Winston Liaw, Andrew Bazemore, Anuradha Jetty, Stephen Petterson, Margot Kushel
The Journal of the American Board of Family Medicine Jul 2019, 32 (4) 521-530; DOI: 10.3122/jabfm.2019.04.180374

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Adults with Housing Insecurity Have Worse Access to Primary and Preventive Care
Patricia Martin, Winston Liaw, Andrew Bazemore, Anuradha Jetty, Stephen Petterson, Margot Kushel
The Journal of the American Board of Family Medicine Jul 2019, 32 (4) 521-530; DOI: 10.3122/jabfm.2019.04.180374
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Keywords

  • Behavioral Risk Factor
  • Chronic Disease
  • Homeless Persons
  • Housing
  • Linear Models
  • Logistic Models
  • Mental Health
  • Multivariate Analysis
  • Outcomes Assessment
  • Primary Health Care
  • Risk-Taking
  • Social Determinants of Health
  • Surveillance System

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