Housing affordability and health among homeowners and renters

Background: Although lack of affordable housing is common in the U.S., few studies have examined the association between housing affordability and health.

Purpose: Using quasi-experimental methods, the aim of this study was to examine whether housing affordability is linked to a number of important health outcomes, controlling for perceptions of neighborhood quality, and determining whether this association differs by housing tenure (renting versus owning).

Methods: Data from the 2008 Southeastern Pennsylvania Household Health Survey, a telephone-based survey of 10,004 residents of Philadelphia and its four surrounding counties, were analyzed. The association between housing affordability and health outcomes was assessed using propensity score methods to compare individuals who reported living in unaffordable housing situations to similar individuals living in affordable ones.

Results: Overall, 48.4% reported difficulty paying housing costs. People living in unaffordable housing had increased odds of poor self-rated health (AOR=1.75, 95% CI=1.33, 2.29); hypertension (AOR=1.34, 95% CI=1.07, 1.69); arthritis (AOR=1.92, 95% CI=1.56, 2.35); cost-related healthcare nonadherence (AOR=2.94, 95% CI=2.04, 4.25); and cost-related prescription nonadherence (AOR=2.68, 95% CI=1.95, 3.70). There were no significant associations between housing affordability and heart disease, diabetes, asthma, psychiatric conditions, being uninsured, emergency department visits in the past year, obesity, and being a current smoker. Renting rather than owning a home heightened the association between unaffordable housing and self-rated health (AOR=2.55, 95% CI=1.93, 3.37 for renters and not significant among homeowners) and cost-related healthcare nonadherence (AOR=4.74, 95% CI=3.05, 7.35 for renters and AOR=1.99, 95% CI=1.15, 3.46 for homeowners).

Conclusions: The financial strain of unaffordable housing is associated with trade-offs that may harm health. Programs that target housing affordability for both renters and homeowners may be an important means for improving health.