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. 2023 Jun;11(3):e003224.
doi: 10.1136/bmjdrc-2022-003224.

Subsidised housing and diabetes mortality: a retrospective cohort study of 10 million low-income adults in Brazil

Renzo Flores-Ortiz  1 , Rosemeire L Fiaccone  2   3 , Alastair Leyland  4 , Christopher Millett  2   5 , Thomas Hone  5 , Maria Inês Schmidt  6 , Andrêa J F Ferreira  2 , Maria Y Ichihara  2 , Camila Teixeira  2 , Mauro N Sanchez  7 , Julia Pescarini  2 , Estela M L Aquino  2   8 , Deborah C Malta  9 , Gustavo Velasquez-Melendez  9 , Juliane Fonseca de Oliveira  2   10 , Peter Craig  11 , Rita C Ribeiro-Silva  2   12 , Mauricio L Barreto  2   8 , Srinivasa Vittal Katikireddi  11
Affiliations

Subsidised housing and diabetes mortality: a retrospective cohort study of 10 million low-income adults in Brazil

Renzo Flores-Ortiz et al. BMJ Open Diabetes Res Care. 2023 Jun.

Abstract

Introduction: Housing-related factors can be predictors of health, including of diabetes outcomes. We analysed the association between subsidised housing residency and diabetes mortality among a large cohort of low-income adults in Brazil.

Research design and methods: A cohort of 9 961 271 low-income adults, observed from January 2010 to December 2015, was created from Brazilian administrative records of social programmes and death certificates. We analysed the association between subsidised housing residency and time to diabetes mortality using a Cox model with inverse probability of treatment weighting and regression adjustment. We assessed inequalities in this association by groups of municipality Human Development Index. Diabetes mortality included diabetes both as the underlying or a contributory cause of death.

Results: At baseline, the mean age of the cohort was 40.3 years (SD 15.6 years), with a majority of women (58.4%). During 29 238 920 person-years of follow-up, there were 18 775 deaths with diabetes as the underlying or a contributory cause. 340 683 participants (3.4% of the cohort) received subsidised housing. Subsidised housing residents had a higher hazard of diabetes mortality compared with non-residents (HR 1.17; 95% CI 1.05 to 1.31). The magnitude of this association was more pronounced among participants living in municipalities with lower Human Development Index (HR 1.30; 95% CI 1.04 to 1.62).

Conclusions: Subsidised housing residents had a greater risk of diabetes mortality, particularly those living in low socioeconomic status municipalities. This finding suggests the need to intensify diabetes prevention and control actions and prompt treatment of the diabetes complications among subsidised housing residents, particularly among those living in low socioeconomic status municipalities.

Keywords: Epidemiology; Mortality; Observational Study; Public Health.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Study population flow chart. CadÚnico, Cadastro Único; FAR, Fundo de Arrendamento Residencial.
Figure 2
Figure 2
Standardised differences of baseline characteristics between subsidised housing residents and non-residents in the observed and IPTW-weighted data. HDI, Human Development Index; IPTW, inverse probability of treatment weights.
See this image and copyright information in PMC

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