Housing instability and cardiometabolic health in the United States: a narrative review of the literature

Abstract

Housing instability is variably defined but generally encompasses difficulty paying rent, living in poor or overcrowded conditions, moving frequently, or spending the majority of household income on housing costs. While there is strong evidence that people experiencing homelessness (i.e., lack of regular housing) are at increased risk for cardiovascular disease, obesity, and diabetes, less is known about housing instability and health. We synthesized evidence from 42 original research studies conducted in the United States examining the association of housing instability and cardiometabolic health conditions of overweight/obesity, hypertension, diabetes, and cardiovascular disease. The included studies varied widely in their definitions and methods of measuring housing instability, but all exposure variables were related to housing cost burden, frequency of moves, living in poor or overcrowded conditions, or experiencing eviction or foreclosure, measured at either the individual household level or at a population level. We also included studies examining the impact of receipt of government rental assistance, which serves as a marker of housing instability given that its purpose is to provide affordable housing for low-income households. Overall, we found mixed but generally adverse associations between housing instability and cardiometabolic health, including higher prevalence of overweight/obesity, hypertension, diabetes, and cardiovascular disease; worse hypertension and diabetes control; and higher acute health care utilization among those with diabetes and cardiovascular disease. We propose a conceptual framework for pathways linking housing instability and cardiometabolic disease that could be targeted in future research and housing policies or programs.

In‐hospital outcomes in unhoused patients with cardiogenic shock in the United States: Insights from The National Inpatient Sample 2011−2019

“…Unhoused patients suffer from decreased life expectancy, 2 high morbidity and mortality, and significant barriers to receiving health care 3 . Median housing costs have risen consistently for the past 10 years, and housing instability has been linked to poor cardiovascular health 4,5 . Governmental and institutional health care support for unhoused patients in the United States varies widely by region, and significant disparities in care exist 6 .…”

“…3 Median housing costs have risen consistently for the past 10 years, and housing instability has been linked to poor cardiovascular health. 4,5 Governmental and institutional health care support for unhoused patients in the United States varies widely by region, and significant disparities in care exist. 6 The average life expectancy of unhoused patients in the United States is 54.14 years, while patients in the top 1% of earnings have a life expectancy of up to 87.3 years.…”

A Review of the Intersectionality of Stress, Relationship Disharmony, and Self-care Among African American Women

“…Recently, the Centers for Disease Control and Prevention declared that racism is a social determinant of stress and health and is a deciding factor of whether or not a person will be discriminated against or experience bias simply because of their race and ethnicity [7]. Furthermore, housing conditions, if poor or if the condition is overcrowded, will also increase stress as privacy and resources become limited [8]. Other indicators of stress include the amount of social support received, relationship status, environmental conditions, and access to healthcare, which can influence the amount of stress in a person's life, ultimately increasing the risk for adverse conditions [8].…”

“…Furthermore, housing conditions, if poor or if the condition is overcrowded, will also increase stress as privacy and resources become limited [8]. Other indicators of stress include the amount of social support received, relationship status, environmental conditions, and access to healthcare, which can influence the amount of stress in a person's life, ultimately increasing the risk for adverse conditions [8]. This review of research attempts to examine how the intersectionality of stress, relationship disharmony, and the previously mentioned indicators affect African American women and their self-care habits.…”