Residential moves and its association with substance use, healthcare needs, and acute care use among homeless and vulnerably housed persons in Canada.

Abstract

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 4years 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.