Document Detail


Food insecurity is associated with greater acute care utilization among HIV-infected homeless and marginally housed individuals in San Francisco.
MedLine Citation:
PMID:  22903407     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: 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.
OBJECTIVE: We examined whether food insecurity was associated with hospitalizations, Emergency Department (ED) visits, and non-ED outpatient visits.
METHODS: 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).
RESULTS: 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).
CONCLUSIONS: 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.
Authors:
Sheri D Weiser; Abigail Hatcher; Edward A Frongillo; David Guzman; Elise D Riley; David R Bangsberg; Margot B Kushel
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2012-08-18
Journal Detail:
Title:  Journal of general internal medicine     Volume:  28     ISSN:  1525-1497     ISO Abbreviation:  J Gen Intern Med     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2013-01-08     Completed Date:  2013-06-27     Revised Date:  2014-01-10    
Medline Journal Info:
Nlm Unique ID:  8605834     Medline TA:  J Gen Intern Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  91-8     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
California
Emergency Service, Hospital / utilization
Female
Food Supply / statistics & numerical data*
HIV Infections / therapy*
Health Services / utilization*
Health Services Research / methods
Homeless Persons / statistics & numerical data*
Hospitalization / statistics & numerical data
Housing / statistics & numerical data*
Humans
Longitudinal Studies
Male
Middle Aged
Outpatient Clinics, Hospital / utilization
Grant Support
ID/Acronym/Agency:
54907//PHS HHS; 79713-01//PHS HHS; K24 MH-87227/MH/NIMH NIH HHS; K24 MH087227/MH/NIMH NIH HHS; R01 MH054907/MH/NIMH NIH HHS
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