Unmet Medical Needs Among Adults Who Move due to Unaffordable Housing: California Health Interview Survey, 2011-2017

Abstract

Background: Stable, affordable housing is an established determinant of health. As affordable housing shortages across the USA threaten to displace people from their homes, it is important to understand the implications of cost-related residential moves for healthcare access.

Objective: To examine the relationship between cost-related moves and unmet medical needs.

Design: We performed a cross-sectional analysis of 7 waves (2011-2017) of the California Health Interview Survey.

Participants: We included all respondents ages 18 and older.

Main measures: The primary predictor variable was residential move history in the past 5 years (cost-related move, non-cost-related move, or no move). The primary outcome was unmet medical needs in the past year (necessary medications and/or medical care that were delayed or not received).

Key results: Our sample included 146,417 adults (42-47% response rate), representing a weighted population of 28,518,590. Overall, 20.3% of the sample reported unmet medical needs in the past year, and 4.9% reported a cost-related move in the past 5 years. In multivariable logistic regression models, adjusted risk of unmet medical needs increased for adults with both cost-related moves (aOR 1.38; 95% CI 1.19-1.59) and non-cost-related moves (aOR 1.17; 95% CI 1.09-1.26) compared to those with no moves. Among people who had moved, those with cost-related moves were more likely to report unmet medical needs compared to people with non-cost-related moves (p = 0.03).

Conclusions: People who have moved due to unaffordable housing represent a population at increased risk for unmet medical needs. Policy makers seeking to improve population health should consider strategies to limit cost-related moves and to mitigate their adverse effects on healthcare access.

Keywords: access to care; affordable housing; delayed care; displacement; housing cost.

Figure 1

Odds ratios of unmet medical needs relative to no move: total sample and stratified by individual characteristics. ***p < 0.001, **p < 0.01, *p < 0.05. Unweighted sample sizes are shown; all other values reflect weighted estimates. Source: Adult California Health Interview Survey, 2011–2017. ^†Odds ratios adjusted for gender, age, age squared, race/ethnicity, employment, log of income as percent of federal poverty level, education, number of adults in household, number of children in household, neighborhood type, health insurance, having a usual source of care, general health status, and survey wave. ^‡Household income as percent of federal poverty level (FPL) stratified by tertiles, roughly corresponding to < 200% of FPL, 200–399% of FPL, and ≥ 400% of FPL. ^§Odds ratios adjusted for gender, age, age squared, race/ethnicity, employment, log of income as percent of federal poverty level, education, number of adults in household, number of children in household, neighborhood type, health insurance, having a usual source of care, and survey wave.

Figure 2

Odds ratios of unmet medical needs relative to no move: stratified by move characteristics. ***p < 0.001, **p < 0.01, *p < 0.05. Unweighted sample sizes are shown; all other values reflect weighted estimates. Source: Adult California Health Interview Survey, 2011–2017. ^†Odds ratios adjusted for gender, age, age squared, race/ethnicity, employment, log of income as percent of federal poverty level, education, number of adults in household, number of children in household, neighborhood type, health insurance, having a usual source of care, general health condition, and survey wave.