Federal Housing Assistance and Blood Lead Levels in a Nationally Representative US Sample Age 6 and Older: NHANES, 1999-2018

Abstract

BACKGROUND: Federal housing assistance is an important policy tool to ensure housing security for low-income households. Less is known about its impact on residential environmental exposures, particularly lead. OBJECTIVES: We conducted a quasi-experimental study to investigate the association between federal housing assistance and blood lead levels (BLLs) in a nationally representative US sample age 6 y and older eligible for housing assistance. METHODS: We used the 1999-2018 National Health and Nutrition Examination Survey (NHANES) linked with US Department of Housing and Urban Development (HUD) administrative records to assess BLLs of NHANES participants with concurrent HUD housing assistance (i.e., current recipients, formula presented ) and those receiving assistance within 2 y after the survey (i.e., pseudo-waitlist recipients, formula presented ). We estimated BLL least squares geometric means (LSGMs), odds ratio (OR) for BLL formula presented , and percent differences in LSGMs by HUD housing assistance status adjusting for age, sex, family income-to-poverty ratio, education, country of birth, race/ethnicity, region, and survey year. We also examined effect modification using interaction terms and stratified analyses by program type [i.e., public housing, multifamily, housing choice vouchers (HCV)], and race/ethnicity. RESULTS: Current HUD recipients had a significantly lower LSGM [formula presented ; 95% confidence interval (CI): 1.02, 1.12] than pseudo-waitlist recipients (formula presented ; 95% CI: 1.14, 1.28), with an adjusted OR of 0.60 (95% CI: 0.42, 0.87) for BLL formula presented . Some effect modification were observed: The protective association of HUD assistance on BLL was strongest among public housing (formula presented LSGM; 95% CI: formula presented ), multifamily (formula presented LSGM; 95% CI: formula presented ), and non-Hispanic White (formula presented LSGM; 95% CI: formula presented ) recipients. It was weaker to null among HCV (formula presented LSGM; 95% CI: formula presented , 1.7%), non-Hispanic Black (formula presented LSGM; 95% CI: formula presented , 5.4%), and Mexican American (-12.5% LSGM; 95% CI: formula presented ) recipients. DISCUSSION: Our research underscores the importance of social-structural determinants like federal housing assistance in providing affordable, stable, and healthy housing to very low-income households. More attention is needed to ensure housing quality and racial equity across HUD's three major housing assistance programs. https://doi.org/10.1289/EHP12645.