County-level housing affordability in relation to risk factors for cardiovascular disease among middle-aged adults: The National Longitudinal Survey of Youths 1979

Abstract

Background: Housing is a fundamental social determinant of health yet housing affordability has diminished over much of the twenty-first century. Research on housing affordability as a determinant of health is limited, but early studies have shown possible correlations with mental health. However, few studies have examined the relationship between housing affordability and risk factors for cardiovascular disease, the leading cause of morbidity and mortality among Americans. Methods: Using a nationally-representative sample of middle-aged adults from the National Longitudinal Survey of Youths 1979 (NLSY79) and exploiting quasi-experimental variation before and after the Great Recession, we estimated the associations between the change in median county-level percentage of household income spent on housing (rent/mortgage) between 2000 and 2008 and individual-level risks of incident hypertension, obesity, diabetes, and depression from 2008 to 2014. We employed conditional fixed effects logistic regression models to reduce bias due to time-invariant confounding. Results: Each percentage point increase in county-level median percentage of household income spent on housing was associated with a 22% increase in the odds of incident hypertension (OR = 1.22, 95% CI = 1.06 to 1.42; p = 0.01), a 37% increased odds of obesity (OR = 1.37, 95% CI = 1.00–1.87; p = 0.049), and a 15% increased odds of depression (OR = 1.15, 95% CI = 1.01–1.31; p = 0.03), controlling for individual- and area-level factors. These associations were stronger among renters than homeowners, and men compared to women. Conclusions: Our findings suggest that lower levels of housing affordability contribute to worse risk profiles for cardiovascular disease. Policies that make housing more affordable may help reduce the population burden of cardiovascular disease.