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Doug Dormer, Kavita Shah, Patrick Lai, Amit Jasti, Josette Jones PhD
The following people also contributed to this study: Curt Sellke, Natalie DiPietro Mager, Kelley Wells.
Studies show that food and housing insecurity associates with poor health. The relationships are complex and multidirectional. Measuring the relationships between food, housing and health status to evaluate the need for and effect of food and housing interventions is difficult. Using data from the 2015 Behavioral Risk Factor Surveillance System, a national survey of health behaviors, our analysis showed that people who always or usually worry about having enough money for food or housing are almost twice as likely to have poor or fair health as people who only sometimes worry, and about three times as likely to have poor or fair health as people who rarely or never worry about having enough money. States with lower rates of food insecurity or housing instability showed lower rates of poor or fair health, compared to states with higher rates of people who always or usually worry about having enough money for food or housing.
Objective: To quantify the associations between food, housing and health using observational data from a common, national survey by estimating the probability of self-reported poor or fair health among persons with high rates of food or housing anxiety in 12 states and to compare these association measures between states.
Methods: A cross-sectional study using data from 12 states that completed the social context module of the 2015 Behavioral Risk Factor Surveillance System (BRFSS) survey. Logistic regressions were conducted to describe associations between food and housing insecurity and health status. Using odds ratios in total and for each state, we estimated the probability that people with different levels of food/housing anxiety would report poor or fair health and the probability that people with poor or fair health would report higher levels of anxiety over food and housing.
Results:
Across all 12 states, we calculated a 48.12% probability that people who are always or usually worried about having enough money for food and housing have poor or fair health, compared to 27.69% probability among people who only sometimes worry about having enough money for food or housing. Among people with poor or fair health, we calculated a 45.00% probability that they will always or usually be worried about money for food compared to only 30.44% of people who report good health. With respect to housing, we calculated a 40.18% probability that people with poor or fair health are always or usually worried about housing compared to a 32.84% probability for people with good health. At the state level, the patterns are generally consistent, although the range varies between those states with better health and lower rates of food/housing insecurity and those having poorer health and higher rates of food/housing insecurity.
Conclusion: The association between food and housing insecurity and health status can be quantified. People who always or usually worry about having enough money for food or housing are significantly more likely to report poor or fair health compared to people who only sometimes or rarely/never worry about having enough money for food or housing. Conversely, people who have poor or fair health are measurably and significantly more likely to report higher rates of anxiety for food and housing than those with good health. While the overall rates varied between states with better health than those with poorer health, the overall relationships within each state were consistent. Additional research is needed to compare these measures with specific interventions and to correlate changes in health status with cost. The results of the 2017 BRFSS, which includes a new social determinants of health module, may provide an ideal opportunity to further this analysis.
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