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.

Keywords:

• HIV
• emergency department
• antiretroviral therapy
• marginalized populations
• housing

Acknowledgments

We are grateful for the contributions of our various research sites, the Community Advisory Committee and study co-investigators. We thank the following individuals who contributed to earlier versions of this work: Wendy Zhang, Eric Druyts, Viviane D. Lima, David Tu, Eric A. Roth, Chris Fraser, Christopher Au-Yeung, as well as Kate Salters and Aneil Parashar for editing support. We would especially like to thank the participants who share their stories in hopes of supporting research projects that will make a difference in their communities. This work is supported by the Canadian Institutes of Health Research (grant number 53396 to R.S.H.). S.P. is the recipient of a CIHR Doctoral Research Award.