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Open Access Research article

A cross-sectional observational study of unmet health needs among homeless and vulnerably housed adults in three Canadian cities

Niran Argintaru1*, Catharine Chambers1, Evie Gogosis1, Susan Farrell2, Anita Palepu3, Fran Klodawsky4 and Stephen W Hwang1

Author affiliations

1 Centre for Research on Inner City Health, Keenan Research Centre in the Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON, Canada

2 Institute of Mental Health Research, University of Ottawa, Ottawa, ON, Canada

3 Department of Medicine, University of British Columbia, Vancouver, BC, Canada

4 School of Geography and Environmental studies, Carlton University, Ottawa, ON, Canada

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Citation and License

BMC Public Health 2013, 13:577  doi:10.1186/1471-2458-13-577

Published: 13 June 2013

Abstract

Background

Homeless persons experience a high burden of health problems; yet, they face significant barriers in accessing health care. Less is known about unmet needs for care among vulnerably housed persons who live in poor-quality or temporary housing and are at high risk of becoming homeless. The objectives of this study were to examine the prevalence of and factors associated with unmet needs for health care in a population-based sample of homeless and vulnerably housed adults in three major cities within a universal health insurance system.

Methods

Participants were recruited at shelters, meal programs, community health centers, drop-in centers, rooming houses, and single room occupancy hotels in Vancouver, Toronto, and Ottawa, Canada, throughout 2009. Baseline interviews elicited demographic characteristics, health status, and barriers to health care. Logistic regression was used to identify factors associated with self-reported unmet needs for health care in the past 12 months.

Results

Of the 1,181 participants included in the analysis, 445 (37%) reported unmet needs. In adjusted analyses, factors associated with a greater odds of reporting unmet needs were having employment in the past 12 months (AOR = 1.40, 95% CI = 1.03–1.91) and having ≥3 chronic health conditions (AOR = 2.17, 95% CI = 1.24–3.79). Having higher health-related quality of life (AOR = 0.21, 95% CI = 0.09–0.53), improved mental (AOR = 0.97, 95% CI = 0.96–0.98) or physical health (AOR = 0.98, 95% CI = 0.96–0.99), and having a primary care provider (AOR = 0.63, 95% CI = 0.46–0.85) decreased the odds of reporting unmet needs.

Conclusions

Homeless and vulnerably housed adults have a similar likelihood of experiencing unmet health care needs. Strategies to improve access to primary care and reduce barriers to accessing care in these populations are needed.

Keywords:
Access to care; Homelessness; Housing; Primary care; Public health policy