Housing and Disability: Social Determinants of Health Utilizing a National Geospatial Analysis 8264

Abstract

Objectives

To demonstrate the macro dynamics of housing and disablement by comparing pressures on a broad range of issues related to housing and disablement across states.

Design

Examination of US Census Data, American Community Survey, using statistical hypothesis testing.

Setting

Data for this nationally representative study are from the American Community Survey, with state-level aggregated measures from the Annual Disability Statistics Compendium.

Participants

Approximately 3,500,000 US adults via the American Community Survey with state-level aggregated measures from the Annual Disability Statistics Compendium.

Interventions

No interventions, this is a natural experiment.

Main Outcome Measures

Housing issues are measured at a state-level percent of community living adults by disability status across 6 housing metrics: lacks a complete kitchen, lacks complete plumbing, overcrowded home environment, housing cost burden, poor housing, and old housing. Housing type is measured by the state-level percent of US community living adults living in houses, apartments, and mobile homes.

Results

Disabled adults are more likely to live in old housing (t=−16.777, P<.001) but less likely to experience all other housing issues: lacks a complete kitchen (t=10.3181, P<.001), lacks complete plumbing (t=5.2579, P<.001), high housing cost burden (t=30.6175, P<.001), and poor housing (t=27.0892, P<.001). The percent of housing with incomplete plumbing per state is strongly positively associated with housing with incomplete kitchens per state (r=0.802, P<.001). States with higher rates of overcrowding have higher housing cost burden (r=0.439, P=.002) and higher rates of poor housing (r=0.496, P<.001). States with high housing cost burden have higher rates of poor housing (r=0.878, P<.001). States that have a high housing cost burden have lower rates of people living in older housing (r=−0.329, P=.017). States with a high rate of poor housing also have a high rate of overcrowded homes (r=0.496, P<.001) and high rate of housing cost burden (r=0.878, P<.001), however, they have lower rates of old housing (r=−0.323, P=.019). States with high rates of old housing have lower housing cost burden (r=−0.329, P=.017) and lower rates of poor housing (r=−0.323, P=.019).

Conclusions

Housing issues disproportionately affect disabled adults in the United States. We argue that the multidimensional nature of housing, through cost burdens, upkeep and maintenance, renting versus ownership, and types of housing prevalent in the United States, creates a paradox of livability versus affordability for disabled adults. In rehabilitation, return to home is substantively dependent on the ability to return to a home. Case Managers and Occupational Therapists should be keenly aware of things findings to help in GAS and case management.

Disclosures

none.