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. 2025 Mar 17:22:100967.
doi: 10.1016/j.ajpc.2025.100967. eCollection 2025 Jun.

The health effects of housing instability and its association with congestive heart failure

Niloufar Novin  1 , S Scott Jones  2   3 , Elizabeth Cohn  2   3 , Nisha Parikh  2   3 , David Zhang  2   3 , Pey-Jen Yu  4 , Kristie Coleman  4 , Luis David Olivera Leon  4 , Codruta Chiuzan  2   3
Affiliations

The health effects of housing instability and its association with congestive heart failure

Niloufar Novin et al. Am J Prev Cardiol. .

Abstract

Housing instability is a critical social determinant of health (SDOH). Prior studies of homelessness and congestive heart failure (CHF) have looked primarily at the association between socioeconomic status and hospitalization. The association between housing instability and the development of CHF has not been fully investigated. We examined data from 4,408 participants with annual household income below $50,000 in the All of Us Research Program, a national cohort study enriched for individuals underrepresented in biomedical research. Within the inceptive survey, participants were asked if they were worried or concerned about not having a place to live in the past 6 months. We assessed the association between this self-reported housing concern and CHF occurrence, finding that individuals with low income and housing instability had a 44 % higher risk of diagnosis of CHF than those with stable housing (HR 1.44; 95 %CI 1.03-2.01). The increased risk remained significant after adjusting for cardiovascular risk factors as potential confounders (HR 1.73; 95 %CI 1.19-2.51) such as cholesterol, history of diabetes, and older age categories aged 55-64 years, 65-74 years, 75 years and older. Compared with men, women in the study were estimated to be at lower risk of CHF diagnosis (HR 0.52; 95 %CI 0.38-0.70) with 5.3 % of men and 2.9 % of women eventually diagnosed. We found that participants with housing instability had a higher risk of diagnosis of CHF compared to those with stable housing, highlighting the potential health impact of this healthcare disparity. Housing instability disrupts the essentials of effective management of cardiovascular risk factors (diabetes, obesity, hypertension) including consistent management, reliable access to care, and access to basic needs like kitchen and bathroom. This exacerbates their severity and increasing the risk of being diagnosed with CHF.

Keywords: All of Us data set; Chronic disease; Congestive heart failure; Healthcare disparity; Heart failure; Housing instability; Social determinants of health; Unhoused; Unstable housing.

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Conflict of interest statement

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Dr. Elizabeth Cohn reports a relationship with IGNITE grant NIH 7OT20D031915-02 that includes: funding grants. Stephen Scott Jones reports a relationship with IGNITE grant NIH 7OT20D031915-02 that includes: funding grants. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Image, graphical abstract
Graphical abstract
Fig. 1
Fig. 1
Flow diagram showing inclusion criteria.
Fig. 2
Fig. 2
Kaplan-Meier Plot for Household Income < $50K.
See this image and copyright information in PMC

References

    1. Bailey P. Center on Budget and Policy Priorities; Washington, DC: 2020. Housing and health partners can work together to close the housing affordability gap.
    1. Long C.L., Franklin S.M., Hagan A.S., et al. Health-related social needs among older adults enrolled In Medicare Advantage. Health Aff (Millwood) 2022;41(4):557–562. - PubMed
    1. Kottke T., Abariotes A., Spoonheim J.B. Access to affordable housing promotes health and well-being and reduces hospital visits. Perm J. 2018;22:17–079. - PMC - PubMed
    1. Koeman J., Mehdipanah R. Prescribing housing: a scoping review of health system efforts to address housing as a social determinant of health. Popul Health Manag. Jun 2021;24(3):316–321. - PubMed
    1. Office of Disease Prevention and Health Promotion . U.S. Department of Health and Human Services; 2024. Housing instability.health.gov/healthypeople/priority-areas/social-determinants-health/liter... Available at: Accessed October 14.

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