• Housing is a critical social determinant of health and health care utilization. • For low-income women of reproductive age, public housing may play an important role. • Women in public housing had fewer outpatient and more emergency department visits. • Significance of associations varied across racial/ethnic group and public housing site. • Race and place are key to understanding public housing and health care utilization. Housing is a key social determinant of health and health care utilization. Although stigmatized due to poor quality, public housing may provide stability and affordability needed for individuals to engage in health care utilization behaviors. For low-income women of reproductive age (15–44 y), this has implications for long-term reproductive health trajectories. In a sample of 5,075 women, we used electronic health records (EHR) data from 2006 to 2011 to assess outpatient and emergency department (ED) visits across six public housing sites in San Francisco, CA. Non-publicly housed counterparts were selected from census tracts surrounding public housing sites. Multivariable regression models adjusted for age and insurance status estimated incidence rate ratios (IRR) for outpatient visits (count) and odds ratios (OR) for ED visit (any/none). We obtained race/ethnicity-specific associations overall and by public housing site. Analyses were completed in December 2020. Public housing was consistently associated with health care utilization among the combined Asian, Alaskan Native/Native American, Native Hawaiian/Pacific Islander, and Other (AANHPI/Other) group. Public housing residents had fewer outpatient visits (IRR: 0.86; 95% Confidence Interval [CI]: 0.81, 0.93) and higher odds of an ED visit (OR: 1.81; 95% CI: 1.32, 2.48). Black women had higher odds of an ED visits (OR: 1.32; 95% CI: 1.07, 1.63), but this was driven by one public housing site (site-specific OR: 2.34; 95% CI: 1.12, 4.88). Variations by race/ethnicity and public housing site are integral to understanding patterns of health care utilization among women of reproductive age to potentially improve women’s long-term health trajectories. 

https://doi.org/10.1016/j.pmedr.2022.101797

Health care utilization among women of reproductive age living in public housing: Associations across six public housing sites in San Francisco

Evidence suggests that being evicted harms health. Largely ignored in the existing literature, however, is the possibility that evictions exert community-level health effects, affecting evicted individuals’ social networks and shaping broader community conditions. In this narrative review, we summarize evidence and lay out a theoretical model for eviction as a community health exposure, mediated through four paths: 1) shifting ecologies of infectious disease and health behaviors, 2) disruption of neighborhood social cohesion, 3) strain on social networks, and 4) increasing salience of eviction risk. We describe methods for parsing eviction's individual and contextual effects and discuss implications for causal inference. We conclude by addressing eviction's potentially multilevel consequences for policy advocacy and cost-benefit analyses. 

Eviction as a community health exposure

Development of a Standardized, Laboratory Result-Based Hepatitis C Virus Clearance Cascade for Public Health Jurisdictions.

• Eviction from rental housing is common throughout the United States and globally. • We synthesize the methods and key findings of recent research on eviction and health. • Most studies found significant links between eviction exposures and poor health. • Some studies found that eviction's impacts were most severe for marginalized groups. • Growing evidence suggests that eviction prevention policies positively impact health. 

Eviction from rental housing and its links to health: A scoping review.

To examine the health-housing relationship in low-income older adults, and differences by income and receipt of housing assistance.Secondary analysis of longitudinal survey data.About 10,858 adults aged 62+ who completed at least one wave of the 2014 Survey of Income and Program Participation (SIPP) (n = 37,333 observations).SIPP variables representing demographics and housing quality, affordability, stability, and neighborhood were analyzed. Low-income and higher-income participants were differentiated by the household income-to-poverty ratio.Low-income participants were significantly more likely to be in poor health and report problems with housing quality, affordability, and neighborhood safety compared to higher-income participants (p < .001). Increased household size and problems with housing quality and neighborhood safety were associated with poor health in both groups (p < .05). Low-income participants who received housing assistance were significantly poorer, less healthy, and food insecure than participants not receiving assistance (p < .001); however, the health-housing relationship was not different in the two groups.Results provide additional support for housing as a social determinant of older adult health. Though housing assistance programs reached a subset of low-income older adults, the results suggest a housing assistance shortfall. Implications for public health nurses and researchers are explored. 

The relationship between health and housing in low-income older adults: A secondary analysis of survey data.

OBJECTIVES This study sought to (1) determine the number of persons evicted from the Durham Housing Authority (DHA) over a 5-year period, (2) explore changes in the number of persons with various medical diagnoses and health care utilization patterns before and after eviction, and (3) examine how many persons evicted from DHA became literally homeless. DESIGN This was a pre/post cross-sectional quantitative study. SAMPLE Heads of households evicted from DHA properties from January 1, 2013 through December 31, 2017 were included in the study. MEASUREMENTS We matched people evicted by the DHA in a university health system electronic health record system to determine changes in diagnoses and health care utilization before and after eviction. We also matched the cohort in the homeless management information system to determine how many persons evicted became literally homeless. RESULTS Findings indicate statistically significant increases in persons with medical diagnoses in five of ten categories, total hospital admissions, and emergency department visits after eviction. Of the 152 people included in the study, 34 (22%) became literally homeless. CONCLUSIONS Health and health care utilization patterns were different before and after eviction. Implications for clinicians are explored.

Changes in health and health care utilization following eviction from public housing.

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Changes in health and health care utilization following eviction from public housing.