Racial-Ethnic Differences in Health Service Use in a Large Sample of Homeless Adults With Mental Illness From Five Canadian Cities

Objective: This study examined factors associated with health care use in an ethnically diverse Canadian sample of homeless adults with mental illness, a particularly disadvantaged group.

Methods: Baseline survey data were available from five sites across Canada for 2,195 At Home/Chez Soi demonstration project participants. Negative binomial regression models examined the relationship between racial-ethnic or cultural group membership (white, N=1,085; Aboriginal, N=476; black, N=244; and other ethnoracial minority groups, N=390) and selfreported emergency department (ED) visits and hospitalizations in the past six months and past-month visits to a medical, other clinical, or social service provider. Adjusted models included other predisposing, enabling, and need factors, based on Andersen’s behavioral model for vulnerable populations.

Results: Compared with white participants, black participants had a lower rate of ED visits (adjusted rate ratio [ARR]=.54, 95% confidence interval [CI]=.43–.69) and Aboriginal participants had a lower rate of medical visits (ARR=.84, CI=.71–.99) and a higher rate of visits to social service providers (ARR=1.54, CI=1.1822.01). Participants in other ethnoracial minority groups had a higher rate of social service provider visits than white participants (ARR=1.44, CI=1.10–1.89). Access to a family physician, having at least high school education, and high needs for mental health services were associated with greater use of ED and medical visits and hospitalizations. Rates of ED and medical visits were lower with increased age and better physical health.

Conclusions: In a system of universal health insurance that prioritizes access to and quality of care, the presence of racial-ethnic disparities experienced by this vulnerable population merits further attention.

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Psychiatric Services