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J Health Care Poor Underserved. 2008 Nov;19(4):1212-28. doi: 10.1353/hpu.0.0068.

Association between the level of housing instability, economic standing and health care access: a meta-regression.

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  • 1Division of General Internal Medicine, University of California-San Francisco, CA 94143, USA.



To determine the relationship between housing instability, economic standing, and access to health care and use of acute care services.


We performed a meta-regression using four nationally representative surveys. The independent variable was an ordered measure of economic and housing instability: 1) the general population, 2) low-income population, 3) never homeless users-of-subsistence-services, 4) unstably housed, 5) formerly homeless, and 6) the actively homeless. Dependent variables were four measures of health care access and three measures of acute health care utilization.


Worsening housing instability and economic standing was associated with poorer access: being uninsured (5.4% per unit increase, 95% CI 1.7-9.2%, p=.011), postponing needed care (3.3%, 95% CI 1.9-4.7%, p=.001), postponing medications (6.1%, 95% CI 1.5-10.6%, p=.035), and with one measure of acute health care utilization: higher hospitalization rates (2.9%, 95% CI 1.2-4.6%, p=.008).


Economic and housing instability should be considered a graded risk factor for poor access to health care.

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