The impact of unstable housing on emergency department use in a cohort of HIV-positive people in a Canadian setting

Abstract

The social–structural challenges experienced by people living with HIV (PHA) have been shown to contribute to increased use of the emergency department (ED). This study identified factors associated with frequent and nonurgent ED use within a cohort of people accessing antiretroviral therapy (ART) in a Canadian setting. Interviewer-administered surveys collected socio-demographic information; clinical variables were obtained through linkages with the provincial drug treatment registry; and ED admission data were abstracted from the Department of Emergency Medicine database. Multivariate logistic regression was used to compute odds of frequent and nonurgent ED use. Unstable housing was independently associated with ED use (adjusted odds ratio [AOR] =1.94, 95% confidence interval [CI] 1.24–3.04]), having three or more ED visits within 6 months of the interview date [AOR: 2.03 (95% CI: 1.07–3.83)] and being triaged as nonurgent (AOR = 2.71, 95% CI: 1.19–6.17). Frequent and nonurgent use of the ED in this setting is associated with conditions requiring interventions at the social–structural level. Supportive housing may contribute to decreased health-care costs and improved health outcomes amongst marginalized PHA.