Health care utilization among women of reproductive age living in public housing: Associations across six public housing sites in San Francisco

Irene E Headen; Leslie Dubbin; Alison J Canchola; Ellen Kersten; Irene H Yen

doi:10.1016/j.pmedr.2022.101797

Health care utilization among women of reproductive age living in public housing: Associations across six public housing sites in San Francisco

Prev Med Rep. 2022 Apr 20:27:101797. doi: 10.1016/j.pmedr.2022.101797. eCollection 2022 Jun.

Authors

Irene E Headen¹, Leslie Dubbin², Alison J Canchola³, Ellen Kersten⁴, Irene H Yen⁵

Affiliations

¹ Drexel University Dornsife School of Public Health, Department of Community Health and Prevention, 3215 Market St., Nesbitt Hall Rm 451, Philadelphia, PA 19104, USA.
² University of California, San Francisco, Department of Social and Behavioral Sciences, School of Nursing, 490 Illinois St., San Francisco, CA 94158, USA.
³ University of California, San Francisco, Department of Epidemiology and Biostatistics, 550 16th. Street, San Francisco CA 94158, USA.
⁴ Washington State Department of Social and Health Services, Research and Data Analysis Division (RDA), 14th & Jefferson St, PO Box 45204, Olympia, WA 98504, USA.
⁵ University of California, Merced, School of Social Sciences Humanities and Arts, Department of Public Health, 5200 N Lake Rd, Merced, CA 95343, USA.

Abstract

Housing is a key social determinant of health and health care utilization. Although stigmatized due to poor quality, public housing may provide stability and affordability needed for individuals to engage in health care utilization behaviors. For low-income women of reproductive age (15-44 y), this has implications for long-term reproductive health trajectories. In a sample of 5,075 women, we used electronic health records (EHR) data from 2006 to 2011 to assess outpatient and emergency department (ED) visits across six public housing sites in San Francisco, CA. Non-publicly housed counterparts were selected from census tracts surrounding public housing sites. Multivariable regression models adjusted for age and insurance status estimated incidence rate ratios (IRR) for outpatient visits (count) and odds ratios (OR) for ED visit (any/none). We obtained race/ethnicity-specific associations overall and by public housing site. Analyses were completed in December 2020. Public housing was consistently associated with health care utilization among the combined Asian, Alaskan Native/Native American, Native Hawaiian/Pacific Islander, and Other (AANHPI/Other) group. Public housing residents had fewer outpatient visits (IRR: 0.86; 95% Confidence Interval [CI]: 0.81, 0.93) and higher odds of an ED visit (OR: 1.81; 95% CI: 1.32, 2.48). Black women had higher odds of an ED visits (OR: 1.32; 95% CI: 1.07, 1.63), but this was driven by one public housing site (site-specific OR: 2.34; 95% CI: 1.12, 4.88). Variations by race/ethnicity and public housing site are integral to understanding patterns of health care utilization among women of reproductive age to potentially improve women's long-term health trajectories.

Keywords: AANHPI/Other, Asian, Alaskan Native/Native American, Native Hawaiian/Pacific Islander, and Other; ED, Emergency Department; EHR, Electronic Health Records; Health care utilization; Housing; RAD, Rental Assistance Demonstration Program; Racial/ethnic disparities; Reproductive health; Social determinants.

Grants and funding

P30 DK092950/DK/NIDDK NIH HHS/United States