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Lack of Food Linked to More Hospitalizations among HIV+ People with Unstable Housing

Homeless and marginally housed people with HIV in San Francisco who experienced "food insecurity" -- lack of stable access to sufficient nutrition -- were more likely to visit the emergency department and more likely to be hospitalized than people with a steady source of adequate food, researchers reported in the August 18, 2012, advance online edition of the Journal of General Internal Medicine.

Sheri Weiser from the Division of HIV/AIDS at San Francisco General Hospital and colleagues conducted a study to assess whether food insecurity is associated with hospitalizations, emergency department (ED) visits, and non-ED outpatient visits by people with HIV.

Food insecurity, or "the uncertain availability of nutritionally adequate, safe foods," has been associated with poor HIV outcomes, the study authors noted as background. But there is little data about the extent to which food insecurity affects patterns of healthcare utilization in this population.

Starting in November 2007, a total of 347 HIV positive homeless or marginally housed individuals participating in the San Francisco Research on Access to Care in the Homeless (REACH) cohort underwent quarterly interviews and blood tests. They were followed for a median of 2 years.

The investigators assessed food insecurity using the Household Food Insecurity Access Scale, categorizing participants as food secure, mild-to-moderately food insecure, or severely food insecure. They compared number of hospitalizations, ED visits, and non-ED outpatient visits after adjusting for demographic (age, sex, race/ethnicity), socioeconomic (education, income, housing status, health insurance), and clinical (lowest-ever CD4 count, time on antiretroviral therapy, depression, illicit drug use) factors.

Results

• 56% of participants were found to be food insecure at the time of enrollment.
• Compared with food-secure individuals, those with severe food insecurity had approximately twice the likelihood of hospitalization (adjusted odds ratio [OR]  2.16) and ED visits (adjusted OR  1.71).
• Although the likelihood of outpatient visits was 41% higher for severely food insecure individuals (adjusted OR 1.41), this difference did not reach statistical significance.
• Mild-to-moderate food insecurity was also associated with increased likelihood of hospitalizations (adjusted OR 1.56), ED visits (adjusted OR 1.57), and outpatient visits (adjusted OR 1.68).
• Food insecurity was a stronger predictor of hospitalization and ED visits than homelessness, drug use, or depression.

Based on these findings, the study authors concluded, "Food insecurity is associated with increased health services utilization among homeless and marginally housed HIV-infected individuals in San Francisco."

They noted that increased ED visits and hospitalizations were not related to food-insecure individuals making fewer ambulatory care visits.

Only 1 in 5 participants took advantage of federal food assistance programs during a 1-year period, according to the researchers, though nearly 75% received some type of food aid including food banks and soup kitchens. They suggested that helping patients sign up for such programs could be an important step towards reducing food insecurity.

"Addressing food insecurity should be a critical component of HIV treatment programs and may reduce reliance on acute care utilization," they recommended.

9/5/12

Reference

SD Weiser, A Hatcher, EA Frongillo, M Kushel, et al. Food Insecurity Is Associated with Greater Acute Care Utilization among HIV-Infected Homeless and Marginally Housed Individuals in San Francisco. Journal of General Internal Medicine. August 18, 2012 (Epub ahead of print).