Associations of Housing, Food, and Dual Insecurity With the Social Determinants of Health Among Older Americans

Abstract

Background

Basic needs such as housing and food security are essential in health and wellbeing among older adults. Adverse social determinants of health (SDOH) increase unmet social needs and barriers to optimal health. The adverse SDOH associated with housing, food, and dual housing-food insecurity are less understood for older adults.

Objective

Using an SDOH framework, this study examined any association between housing, food, and dual insecurity, and the SDOH among older US adults.

Study Design, Settings, Participants

This cross-sectional study used nationally representative data from the 2022 National Health Interview Survey for adults aged 65 and older (N=8,835).

Measurable Outcome/Analysis

Outcome measures were housing insecurity (receipt of housing assistance), food insecurity (based on the USDA Adult Food Security Module), and dual insecurity. Controlling for individual heterogeneity, stratified logistic regression models were used to evaluate associations between food, housing, and dual insecurity, and the SDOH.

Results

Regression analyses showed significantly higher likelihoods of housing insecurity among Blacks (OR=3.36, CI=2.42, 4.68), individuals with less than a high school education background (OR= 2.02, CI=1.20, 3.41), and low-income earners (OR= 29.49, CI=12.94, 67.21) relative to their counterparts, but a relatively lower likelihood of housing insecurity among those in larger households (OR= 0.28, CI=0.18, 0.44). Individuals with only a high school education background (OR= 1.92, CI=1.29, 2.87), Blacks (OR=1.88, CI=1.30, 2.72), low-income earners (OR=10.38, CI=5.76, 18.69), and those without reliable transportation (OR= 2.99, CI=2.06, 4.34) were more likely to experience food insecurity. Dual insecurity was a more likely challenge among individuals without reliable transportation (OR=6.57, CI=2.82, 15.31), Blacks (OR=2.28, CI=1.07, 4.85), and low-income earners (OR=16.59, CI=2.30, 119.71), but less likely among those in larger households (OR=0.17, CI=0.05, 0.62).

Conclusions

Income, race, and limited availability of material resources are associated with housing, food, and dual insecurity. Our findings highlight the need to address unmet basic needs, specifically, housing and food insecurity challenges among low-income and racially minoritized older adults. Additional research is needed to inform the best course of mitigation.

Funding

None