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Food Insufficiency and Health Services Utilization in a National Sample of Homeless Adults
Open accessAbstract
Background Homeless people have high rates of hospitalization and emergency department (ED) use. Obtaining adequate food is a common concern among homeless people and may influence health care utilization.Objective We tested the hypothesis that food insufficiency is related to higher rates of hospitalization and ED use in a national sample of homeless adults.Design We analyzed data from the 2003 Health Care for the Homeless (HCH) User Survey.Participants Participants were 966 adults surveyed at 79 HCH clinic sites throughout the US. The study sample was representative of over 436,000 HCH clinic users nationally.Measures We determined the prevalence and characteristics of food insufficiency among respondents. Using multivariable logistic regression, we examined the association between food insufficiency and four past-year acute health services utilization outcomes: (1) hospitalization for any reason, (2) psychiatric hospitalization, (3) any ED use, and (4) high ED use (≥ 4 visits).Results Overall, 25% of respondents reported food insufficiency. Among them, 68% went a whole day without eating in the past month. Chronically homeless (p = 0.01) and traumatically victimized (p = 0.001) respondents were more likely to be food insufficient. In multivariable analyses, food insufficiency was associated with significantly greater odds of hospitalization for any reason (AOR 1.59, 95% CI 1.07, 2.36), psychiatric hospitalization (AOR 3.12, 95% CI 1.73, 5.62), and high ED utilization (AOR 2.83, 95% CI 1.32, 6.08).Conclusions One-fourth of homeless adults in this national survey were food insufficient, and this was associated with increased odds of acute health services utilization. Addressing the adverse health services utilization patterns of homeless adults will require attention to the social circumstances that may contribute to this issue.
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“Homeless individuals have worse physical and emotional health status than the general population, including those from deprived neighbourhoods.32,49-51”
From The health of homeless people in high-income countries: descriptive epidemiology, health consequences, and clinical and policy recommendations (2014) · cites this paper as [50]
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Metadata
- Authors
- Baggett, T. P., Singer, D. E., Rao, S. R., O’Connell, J. J., Bharel, M., & Rigotti, N. A.
- Affiliations
- Massachusetts General Hospital (US)
- Harvard University (US)
- Corresponding author
- Baggett, Travis P.
- Venue
- Journal of General Internal Medicine
- Published
- 2011-01-29
- Volume
- 26
- Issue
- 6
- Pages
- 627-634
- ISSN
- 0884-8734 (ISSN-L)
- 1525-1497
- PMC
- PMC3101971
- OpenAlex
- W2094329398
- Cited by
- 105
- References
- 48
- Citations by year
- 2026: 3 · 2025: 3 · 2024: 2 · 2023: 5 · 2022: 7 · 2021: 10 · 2020: 10 · 2019: 9 · 2018: 11 · 2017: 6 · 2016: 6 · 2015: 11 · 2014: 5 · 2013: 10 · 2012: 5
- FWCI
- 13.06
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Journal of General Internal Medicine (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- The Journal of the American Medical Association (JAMA) Network (American Medical Association) (submittedVersion)
- Funders
- U.S. Department of Health and Human Services
- Health Resources and Services Administration (T32 HP10251)
- U.S. Public Health Service (T32 HP10251)
- National Center for Research Resources (UL1RR031982)
- Topics
- Social Sciences › Sociology and Political Science › Homelessness and Social Issues
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Food Security and Health in Diverse Populations
- Life Sciences › Agricultural and Biological Sciences › General Agricultural and Biological Sciences › Food Security and Socioeconomic Dynamics
- Keywords
- food insufficiency, homelessness, health care utilization, hospitalization, emergency department utilization, psychiatric hospitalization, chronic homelessness, food insecurity
- MeSH terms
- Adult, Data Collection, Eating, Female, Food Supply, Health Services, Ill-Housed Persons, Hospitalization, Humans, Male, Middle Aged, Nutritional Status, Patient Acceptance of Health Care, United States, Malnutrition
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