Subsidized Housing Availability and Preventive Care Utilization in US Neighborhoods

Abstract

Introduction: Access to affordable housing might impact participation in preventive care through economic and social pathways. Government housing subsidies are available for some income-eligible populations, but their reach is limited. In this study, we examine associations between subsidized housing availability and participation in routine preventive care services in US neighborhoods overall and by area-level poverty. Methods: Census tract-level data for 2018–2019 were derived from publicly available sources. Dependent variables included prevalence estimates of breast, cervical, and colorectal cancer screening and cholesterol screening. Subsidized housing availability was classified according to quintiles (Q1 = lowest to Q5 = highest). Tract poverty level was classified as low (< 20% below poverty), high (20% to < 40%), or extreme (≥ 40%). We used weighted multivariable linear regression to estimate differences in screening prevalence by subsidized housing availability and tract poverty, controlling for sociodemographic and healthcare access characteristics. Results: Data from 70,006 tracts were analyzed. In adjusted models, cervical and cholesterol screening increased monotonically across quintiles of subsidized housing in extreme-poverty areas; cervical screening was 5.47 (95% CI = 5.20–5.73) percentage points higher in Q5 (81.3%) than Q1 (75.8%). Differences were similar in magnitude for cholesterol screening. Within poverty strata, differences in breast and colorectal screening across quintiles of subsidized housing were minimal (< 1%). Conclusions: Subsidized housing availability was associated with higher cervical cancer and cholesterol screening in extreme-poverty areas. These ecological associations support hypotheses about the benefit of social needs programming on utilization of preventive care services in under-resourced settings.