Brief Report: Characterizing the Burden of Cardiometabolic Disease among Public Housing Residents Served by an Urban Hospital System

Abstract

Objective: Housing status is a primary social determinant of health that is not typically not collected in clinical settings. Residential address data collected during clinical visits can identify patients at high-risk for cardiometabolic disease (CMD) residing in public housing.

Design: This study examined CMD and related risk factors among patients living in public housing and a comparison group not living in public housing.

Setting: All patients (n=173,568) were receiving primary care in a large hospital system in the Bronx, New York between January 1, 2016 and December 31, 2017.

Results: Patients in public housing were more likely to be women, to be Black or Hispanic, and to be on Medicaid compared with patients not living in public housing. Women in public housing were more likely than men to have had a higher prevalence of CMD and related risk factors.

Conclusion: The burden of CMD among public housing residents shows sex disparities where women have a higher prevalence of CMD and related risk factors than men.

Keywords: Cardiometabolic Disease; Electronic Health Record (EHR); Obesity; Public Housing; Smoking.

Figure 1.. CMD outcomes and risk factors: obesity, hypertension, prediabetes

Case Definitions: Obesity, body mass index ≥ 30 kg/m²; hypertension, ICD-10 diagnosis (I10); Prediabetes, hemoglobin A1C 5.7-6.4% and no prior evidence of diabetes (using diabetes definition found in Figure 2 definitions). *.011 p-interaction only shown when P<.05 for crude analysis; and ² for adjusted analysis. All analyses adjusted for age, race/ethnicity, insurance status, the number of primary care visits, area-level percent below the poverty level, % non-Hispanic Black, and % Hispanic. All area-level measures at the census block-group level from the 2012-2016 American Community Survey 5-year estimates.

Figure 2.. CMD outcomes and risk factors: smoking, diabetes, high cholesterol

Case Definitions: Current smoking, positive response to screening question regarding current cigarette use; Diabetes, ICD-10 diagnosis (E10.X, E11.X, E13.X) or inclusion of diabetes on patient problem list (excluding gestational diabetes) or use of anti-diabetic agents excluding metformin or hemoglobin A1C≥7.0%; High cholesterol, ICD-10 diagnosis (E78.5). *.011 p-interaction only shown when P<.05 for crude analysis; and ² for adjusted analysis. All analyses adjusted for age, race/ethnicity, insurance status, the number of primary care visits, area-level percent below the poverty level, % non-Hispanic Black, and % Hispanic. All area-level measures at the census block-group level from the 2012-2016 American Community Survey 5-year estimates.

Figure 3.. CMD outcomes and risk factors: ischemic heart disease, heart failure, stroke

Case Definitions: Ischemic heart disease, ICD-10 diagnosis (I20.X, I21.X, 122.X, 123.X, 124.X, I25.X); Heart failure, ICD-10 diagnosis (I50.X); Stroke, ICD-10 diagnosis (I60.X) *.011 p-interaction only shown when P<.05 for crude analysis; and ² for adjusted analysis. All analyses adjusted for age, race/ethnicity, insurance status, the number of primary care visits, area-level percent below the poverty level, % non-Hispanic Black, and % Hispanic. All area-level measures at the census block-group level from the 2012-2016 American Community Survey 5-year estimates.