Abstract 016: Lower Levels of County Housing Affordability Are Linked to Worse Cardiometabolic Risk Profiles in Middle-Aged and Older Adults

Abstract

Introduction: Housing is a fundamental social determinant of health. Past studies have shown that high levels of unaffordable housing raise residents’ chances of moving, often redistributing individuals into socioeconomically disadvantaged neighborhoods and dwellings. This may simultaneously expose individuals to health-detrimental factors while limiting their exposure to health-promoting factors. Residents within unaffordable housing areas may also experience adverse physical and mental health outcomes through various psychosocial, behavioral and material pathways. Yet few studies have examined the relationship between housing affordability and risk factors for cardiovascular disease, the leading cause of morbidity and mortality among Americans. Hypothesis: We investigated the hypothesis that lower levels of county housing affordability are linked to higher odds of incident hypertension, diabetes, obesity, and depression. Methods: Using a nationally-representative sample of 3,722 middle-aged to older adults from the National Longitudinal Survey of Youths 1979 and exploiting quasi-experimental variation before and after the Great Recession, we estimated the associations between the change in median county-level percentage of household income spent on housing (rent, mortgage) between 2000 and 2008 and individual-level odds of incident hypertension, obesity, diabetes, and depression during the follow-up period 2008-2014. Incidence of hypertension and diabetes was assessed through survey-reported physician diagnosis. Obesity was defined as a BMI ≥ 30 kg/m 2 , and depression was measured using the 7-item Center for Epidemiologic Studies Depression Scale and designated based on a cut-off score of 7. We employed fixed effects logistic regression models to reduce bias due to time-invariant confounding. Results: Each percentage point increase in the median county-level percentage of household income spent on rent or mortgage was associated with a 17% increase in the odds (OR = 1.17, 95% CI = 1.00 to 1.39; p = 0.047) of incident hypertension, a 37% increase in the odds (OR = 1.37, 95% CI = 1.00 to 1.87; p = 0.049) of obesity, and a 15% increased odds (OR = 1.15, 95% CI = 1.01 to 1.31; p = 0.030) of depression, controlling for individual- and area-level demographic and socioeconomic factors. No association was observed for diabetes. These associations were stronger among renters than among homeowners, and in men compared to women. In sensitivity analyses, these findings were robust when we limited the sample to non-movers and when we used alternative depression score cut-points. Conclusions: Our findings suggest that lower levels of housing affordability contribute to worse risk profiles for cardiovascular disease. Policies that make housing more affordable may help to reduce the population burden of cardiovascular disease.