The health effects of housing instability and its association with congestive heart failure

Abstract

Housing instability is a critical social determinant of health (SDOH). Prior studies of homelessness and congestive heart failure (CHF) have looked primarily at the association between socioeconomic status and hospitalization. The association between housing instability and the development of CHF has not been fully investigated.

We examined data from 4,408 participants with annual household income below $50,000 in the All of Us Research Program, a national cohort study enriched for individuals underrepresented in biomedical research. Within the inceptive survey, participants were asked if they were worried or concerned about not having a place to live in the past 6 months. We assessed the association between this self-reported housing concern and CHF occurrence, finding that individuals with low income and housing instability had a 44 % higher risk of diagnosis of CHF than those with stable housing (HR 1.44; 95 %CI 1.03–2.01). The increased risk remained significant after adjusting for cardiovascular risk factors as potential confounders (HR 1.73; 95 %CI 1.19–2.51) such as cholesterol, history of diabetes, and older age categories aged 55–64 years, 65–74 years, 75 years and older.

Compared with men, women in the study were estimated to be at lower risk of CHF diagnosis (HR 0.52; 95 %CI 0.38–0.70) with 5.3 % of men and 2.9 % of women eventually diagnosed. We found that participants with housing instability had a higher risk of diagnosis of CHF compared to those with stable housing, highlighting the potential health impact of this healthcare disparity. Housing instability disrupts the essentials of effective management of cardiovascular risk factors (diabetes, obesity, hypertension) including consistent management, reliable access to care, and access to basic needs like kitchen and bathroom. This exacerbates their severity and increasing the risk of being diagnosed with CHF.