Public Housing and Healthcare Use: an Investigation Using Linked Administrative Data

Overview

Journal Can J Public Health

Publisher Springer Nature

Specialty Public Health

Date 2018 Dec 15

PMID 30547290

Citations 4

Authors

Aynslie M Hinds

Brian Bechtel

Jino Distasio

Leslie L Roos

Lisa M Lix

Affiliations

Soon will be listed here.

Abstract

Objective: This study investigated whether a move to public housing affects people's use of healthcare services.

Method: Using administrative data from Manitoba, the number of hospitalizations, general practitioner (GP), specialist and emergency department (ED) visits, and prescription drugs dispensed in the years before and after the housing move-in date (2012/2013) were measured for a public housing and matched cohort. Generalized linear models with generalized estimating equations tested for differences between the cohorts in utilization trends. The data were modeled using Poisson (rate ratio, RR), negative binomial (incident rate ratio, IRR), and binomial (odds ratio, OR) distributions.

Results: GP visits (IRR = 1.04, 95% CI 1.01-1.06) and prescriptions (IRR = 1.04, 95% CI 1.02-1.05) increased, while ED visits (RR = 0.90, 95% CI 0.82-1.00) and hospitalizations (OR = 0.95, 95% CI 0.93-0.96) decreased over time. The public housing cohort had a significantly higher rate of GP visits (IRR = 1.08, 95% CI 1.04-1.13), ED visits (RR = 1.18, 95% CI 1.01-1.37), and prescriptions (IRR = 1.09, 95% CI 1.05-1.13), and was more likely to be hospitalized (OR = 1.39, 95% CI 1.21-1.61) compared to the matched cohort. The rate of inpatient days significantly decreased for the public housing cohort, but did not change for the matched cohort.

Conclusion: Healthcare use changed similarly over time (except inpatient days) for the two cohorts. Public housing provides a basic need to a population who has a high burden of disease and who may not be able to obtain and maintain housing in the private market.

Citing Articles

Rental Housing Type and Self-Reported General Health and Mental Health Status: Evidence from the Canadian Housing Survey 2018-2019.

Kader S, Ahmed M, Desjarlais-deKlerk K, Leloup X, Simard L, Leviten-Reid C Int J Environ Res Public Health. 2024; 21(9).

PMID: 39338064 PMC: 11431059. DOI: 10.3390/ijerph21091181.

A Good Farewell? Positive Exits from Federal Housing Assistance and Lower Acute Healthcare Utilization.

Matheson A, Colombara D, Pennucci A, Chan A, Shannon T, Suter M J Urban Health. 2023; 100(6):1202-1211.

PMID: 38012503 PMC: 10728032. DOI: 10.1007/s11524-023-00789-w.

Association of Promoting Housing Affordability and Stability With Improved Health Outcomes: A Systematic Review.

Chen K, Miake-Lye I, Begashaw M, Zimmerman F, Larkin J, McGrath E JAMA Netw Open. 2022; 5(11):e2239860.

PMID: 36322083 PMC: 9631101. DOI: 10.1001/jamanetworkopen.2022.39860.

Health care utilization among women of reproductive age living in public housing: Associations across six public housing sites in San Francisco.

Headen I, Dubbin L, Canchola A, Kersten E, Yen I Prev Med Rep. 2022; 27:101797.

PMID: 35656210 PMC: 9152803. DOI: 10.1016/j.pmedr.2022.101797.

References

Iron K, Goel V . Sex differences in the factors related to hospital utilization: results from the 1990 Ontario Health Survey. J Womens Health. 1998; 7(3):359-69. DOI: 10.1089/jwh.1998.7.359. View

Bazargan M, Norris K, Bazargan-Hejazi S, Akhanjee L, Calderon J, Safvati S . Alternative healthcare use in the under-served population. Ethn Dis. 2005; 15(4):531-9. View

Duchon L, Weitzman B, Shinn M . The relationship of residential instability to medical care utilization among poor mothers in New York City. Med Care. 1999; 37(12):1282-93. DOI: 10.1097/00005650-199912000-00011. View

Latimer E, Rabouin D, Cao Z, Ly A, Powell G, Aubry T . Costs of services for homeless people with mental illness in 5 Canadian cities: a large prospective follow-up study. CMAJ Open. 2017; 5(3):E576-E585. PMC: 5621955. DOI: 10.9778/cmajo.20170018. View

Sibley L, Moineddin R, Agha M, Glazier R . Risk adjustment using administrative data-based and survey-derived methods for explaining physician utilization. Med Care. 2009; 48(2):175-82. DOI: 10.1097/MLR.0b013e3181c16102. View

Cummings J, Allen L, Ko M, Bonney L, Hunter-Jones J, Cooper H . Changes in healthcare access and utilization among participants in a public housing relocation program in Atlanta, Georgia. Health Place. 2016; 42:63-68. PMC: 5389413. DOI: 10.1016/j.healthplace.2016.07.006. View

Lix L, Yao X, Kephart G, Quan H, Smith M, Kuwornu J . A prediction model to estimate completeness of electronic physician claims databases. BMJ Open. 2015; 5(8):e006858. PMC: 4554902. DOI: 10.1136/bmjopen-2014-006858. View

De Boer A, Wijker W, de Haes H . Predictors of health care utilization in the chronically ill: a review of the literature. Health Policy. 1997; 42(2):101-15. DOI: 10.1016/s0168-8510(97)00062-6. View

Mackenzie C, Gekoski W, Knox V . Age, gender, and the underutilization of mental health services: the influence of help-seeking attitudes. Aging Ment Health. 2006; 10(6):574-82. DOI: 10.1080/13607860600641200. View

10.

Battaglia T, Murrell S, Gees Bhosrekar S, Caron S, Bowen D, Smith E . Connecting Boston's public housing developments to community health centers: who's ready for change?. Prog Community Health Partnersh. 2012; 6(3):239-48. DOI: 10.1353/cpr.2012.0035. View

11.

Kushel M, Perry S, Bangsberg D, Clark R, Moss A . Emergency department use among the homeless and marginally housed: results from a community-based study. Am J Public Health. 2002; 92(5):778-84. PMC: 1447161. DOI: 10.2105/ajph.92.5.778. View

12.

Simning A, van Wijngaarden E, Conwell Y . Anxiety, mood, and substance use disorders in United States African-American public housing residents. Soc Psychiatry Psychiatr Epidemiol. 2010; 46(10):983-92. PMC: 3044217. DOI: 10.1007/s00127-010-0267-2. View

13.

Diez-Roux A, Kiefe C, Jacobs Jr D, Haan M, Jackson S, Nieto F . Area characteristics and individual-level socioeconomic position indicators in three population-based epidemiologic studies. Ann Epidemiol. 2001; 11(6):395-405. DOI: 10.1016/s1047-2797(01)00221-6. View

14.

Baker R, Bazargan M, Bazargan-Hejazi S, Calderon J . Access to vision care in an urban low-income multiethnic population. Ophthalmic Epidemiol. 2005; 12(1):1-12. DOI: 10.1080/09286580590921330. View

15.

Watson D, Katz A, Reid R, Bogdanovic B, Roos N, Heppner P . Family physician workloads and access to care in Winnipeg: 1991 to 2001. CMAJ. 2004; 171(4):339-42. PMC: 509046. DOI: 10.1503/cmaj.1031047. View

16.

Fertig A, Reingold D . Public housing, health and health behaviors: is there a connection?. J Policy Anal Manage. 2007; 26(4):831-59. DOI: 10.1002/pam.20288. View

17.

Wiggers J, Radvan D, Clover K, Hazell T, Alexander J, Considine R . Public housing, public health: health needs of public housing tenants. Aust N Z J Public Health. 2001; 25(2):111-4. DOI: 10.1111/j.1753-6405.2001.tb01830.x. View

18.

Digenis-Bury E, Brooks D, Chen L, Ostrem M, Horsburgh C . Use of a population-based survey to describe the health of Boston public housing residents. Am J Public Health. 2007; 98(1):85-91. PMC: 2156072. DOI: 10.2105/AJPH.2006.094912. View

19.

Gelberg L, Andersen R, Leake B . The Behavioral Model for Vulnerable Populations: application to medical care use and outcomes for homeless people. Health Serv Res. 2000; 34(6):1273-302. PMC: 1089079. View

20.

Cooper H, Wodarski S, Cummings J, Hunter-Jones J, Karnes C, Ross Z . Public housing relocations in Atlanta, Georgia, and declines in spatial access to safety net primary care. Health Place. 2012; 18(6):1255-60. PMC: 3501556. DOI: 10.1016/j.healthplace.2012.08.007. View