Housing Insecurity and Risk of Adverse Kidney Outcomes

Abstract

BackgroundHousing insecurity is characterized by high housing costs or unsafe living conditions that prevent self-care and threaten independence. We examined the relationship of housing insecurity and risk of kidney disease.MethodsWe used longitudinal data from the Healthy Aging in Neighborhoods of Diversity across the Life Span study (Baltimore, MD). We used multivariable regression to quantify associations between housing insecurity and rapid kidney function decline (loss of >5 ml/min per 1.73 m2 of eGFR per year) and, among those without kidney disease at baseline, incident reduced kidney function (eGFR <60 ml/min per 1.73 m2) and incident albuminuria (urine albumin-creatinine ratio [ACR] ≥30 mg/g).ResultsAmong 1262 participants, mean age was 52 years, 40% were male and 57% were black. A total of 405 (32%) reported housing insecurity. After a median of 3.5 years of follow-up, rapid kidney function decline, incident reduced kidney function, and incident albuminuria occurred in 199 (16%), 64 (5%), and 74 (7%) participants, respectively. Housing insecurity was associated with increased odds of incident albuminuria (unadjusted OR, 2.04; 95% CI, 1.29 to 3.29; adjusted OR, 3.23; 95% CI, 1.90 to 5.50) but not rapid kidney function decline or incident reduced kidney function.ConclusionsIn this urban population, housing insecurity was associated with increased risk of subsequent albuminuria. Increased recognition of housing insecurity as a social determinant of kidney disease is needed, and risk-reduction efforts that specifically target populations experiencing housing insecurity should be considered.

Ensuring the Equitable Advancement of American Kidney Health—the Need to Account for Socioeconomic Disparities in the ESRD Treatment Choices Model

“…7 Patients with housing instability represent a high-risk, understudied population suffering from insufficient housing, homelessness, or financial insecurity coupled with high housing costs. 6,8 Housing instability virtually precludes the use of home dialysis, limiting patient choice. 5,6 Further, limited data suggest higher rates of worsening albuminuria and progression of CKD, in-center dialysis, missed dialysis treatments, emergency-only dialysis, hospitalizations, and health care costs.…”

“…5,6 Further, limited data suggest higher rates of worsening albuminuria and progression of CKD, in-center dialysis, missed dialysis treatments, emergency-only dialysis, hospitalizations, and health care costs. 6,8 Without appropriate risk adjustment, participants who care for patients with housing instability are at risk for financial penalties under PPA, leading to disincentives to provide equitable care for disadvantaged patient populations. Similarly, social determinants influence the likelihood of transplant wait listing and living donation; without appropriate adjustment, ETC participants are disincentivized from accepting patients with perceived barriers to transplantation.…”

Health-Related Social Needs and Kidney Risk Factor Control in an Urban Population

“…Elizabeth A. Jacobs, MD, MAPP 3,4 ; Alan Zonderman, PhD 5 ; Michele K. Evans, MD 5 ; Deidra C. Crews, MD, ScM 2,6,7 Supplementary Material J o u r n a l P r e -p r o o f…”

“…Individuals experiencing health-related social needs, such as housing and food insecurity, face significant health care barriers and are at increased risk for chronic kidney disease (CKD) and end-stage kidney disease. 1 , 2 , 3 , 4 , 5 Maintaining blood pressure at ≤130/80 mm Hg, hemoglobin A 1c level of 7%, sodium intake < 2.000 mg/d, body mass index (BMI) ≤ 25 kg/m 2 , regular physical activity, and smoking cessation reduce the risk for CKD and CKD progression. 6 We examined whether experiencing social needs was associated with kidney protective measures and hypothesized that those experiencing social needs would achieve fewer kidney protective measures.…”

COVID-19 and Kidney Disease Disparities in the United States

“…51 Increasing financial resource strain increases risk for incident albuminuria and rapid kidney function decline, and the economic impact of COVID-19 alone may result in a higher prevalence of kidney disease and kidney disease progression in this population. 52 Undocumented immigrants are not eligible for the Affordable Care Act, and there are an estimated 7.1 million without health insurance. 53 Without insurance, undocumented immigrants do not have consistent access to primary care, and undiagnosed or poorly controlled chronic conditions increase their risk for severe complications from COVID-19 if infected.…”