Low-income US renters face a severe affordable housing crisis that likely has adverse effects on population health. The current affordable housing shortage is likely to have particularly significant implications for the health of adults living with behaviorally managed chronic conditions such as type 2 diabetes. Type 2 diabetes requires complex and resource intensive daily management that is highly sensitive to social conditions such as housing. Furthermore, the rising prevalence of type 2 diabetes and diabetes related complications are unequally borne by low-income adults and racial minorities; two populations that are at greater risk of housing challenges. Rental assistance, provided by the US Department of Housing and Urban Development (HUD) is a primary source of affordable housing for low-income households. However, due to supply constraints, fewer than 1 in 4 eligible households receive this resource and waiting lists average 26 months nationally. Access to rental assistance may improve diabetes self-management and control by reducing housing costs that can compete with diabetes-related expenses and by providing stability that allows individuals to establish and maintain consistent self-management routines. Furthermore, the unmet need for rental assistance creates a unique opportunity to study the effects of affordable housing on health through rigorous approaches that compare waitlisted and rent-assisted individuals. The primary goals of this study are to estimate the effects of rental assistance on biological and behavioral indicators of diabetes self-management and control, and to examine the processes through which these effects occur. Our project has three aims: 1) To estimate the effects of rental assistance on type 2 diabetes self-management and control using a unique linkage of HUD administrative data and a nationally representative health survey. 2) To examine how transitions from rental assistance waiting lists into rent-assisted housing are associated with changes in diabetes self-management and control in a longitudinal cohort of adults with type 2 diabetes 3) To examine how experiences of waiting for and obtaining rental assistance shape diabetes behaviors and outcomes using qualitative interviews conducted with a sub-sample of aim 2 participants. Findings will inform whether and how rental assistance and other housing interventions can be leveraged to improve diabetes outcomes and to reduce diabetes disparities. Furthermore, by identifying processes that connect housing to health, findings will inform clinical and behavioral interventions to improve diabetes outcomes for inadequately housed adults, even in the absence of expanded housing access. Beyond diabetes, findings will serve as a model for understanding relationships between affordable housing access and chronic disease management behaviors more broadly.
This study examines whether and how expanded access to affordable housing through rental assistance programs can improve type 2 diabetes self-management and control, ultimately reducing existing socioeconomic and racial disparities in diabetes outcomes. The study will examine the effect of rental assistance on diabetes self-management and control using nationally representative survey data, and by prospectively observing transitions from waitlists to rent-assisted housing through a longitudinal mixed- methods cohort study.
