Affordable housing associated with reduced likelihood of uncontrolled diabetes: JAMA

USA: Receiving housing rental assistance is associated with improved diabetes outcomes among middle-aged and older adults, reports an article published in the JAMA Network Open.

The worldwide crisis of affordable housing has increasingly strained the ability of low-income families to obtain decent and stable housing. Health and health-related problems result from a complex interplay of several factors, including social determinants of health. Unaffordable, unsafe, and unstable housing has negative consequences on the health of an individual. Frequent moves and high rent burdens have been associated with an increased risk of diabetes and can make it more difficult to manage chronic conditions such as diabetes that require complex behaviors, adherence to medications, and regular health care visits.

"To our knowledge, no quantitative studies have examined whether rental assistance is associated with improved glycemia and related diabetes outcomes, although qualitative evidence suggests that rental assistance may facilitate diabetes management," the authors wrote. 

Andrew Fenelon, Penn State University, Pennsylvania, USA, and his team conducted a study to assess whether 2 different types of federal rental assistance programs are associated with glycated hemoglobin A1c (HbA1c) levels among middle-aged and older adults.

Investigators used data from 1050 adults(41.6% aged ≥65 years; 70.1% female) from the National Health and Nutrition Examination Survey (NHANES). Of all,795 were receiving rental assistance at the time of the NHANES interview (450 lived in project-based housing, and 345 had housing vouchers), and 255 received rental assistance within 2 years after the interview. The primary outcome was a continuous HbA1c level. Linear regression was used to estimate the association between the 2 rental assistance programs and the HbA1c level. Logistic regression was used to assess the association between rental assistance programs and HbA1c cut points (prediabetes: 5.7% to ≤6.5%; diabetes: >6.5%; uncontrolled diabetes: ≥9).

Key findings of the study,

• Participants in project-based housing had lower HbA1c levels compared with individuals in the waitlist group, but the difference was not significant.

• There were no significant differences in HbA1c levels between those receiving housing vouchers and those in the waitlist group.

• Receiving project-based housing was associated with a reduced likelihood of uncontrolled diabetes (−3.7 percentage points) compared with being in the waitlist group.

The investigators conclude that participants who were receiving rental assistance through project-based housing were less likely to have an HbA1c level indicating uncontrolled diabetes compared with participants who would receive project-based housing within 2 years. Significant associations were not found for housing vouchers. Thus, affordable housing programs may be associated with improved diabetes outcomes.

The study findings suggest that the mobility benefits of housing vouchers may need to be balanced against the increasing evidence for the health benefits of project-based housing.

Reference:

Fenelon A, Lipska KJ, Denary W, et al. Association Between Rental Assistance Programs and Hemoglobin A1c Levels Among US Adults. JAMA Netw Open. 2022;5(7):e2222385. doi:10.1001/jamanetworkopen.2022.22385