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Abstract: SA-PO844

Housing Insecurity and Healthcare Engagement Among People with CKD

Session Information

Category: CKD (Non-Dialysis)

  • 2101 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

  • Novick, Tessa Kimberly, University of Texas Dell Medical School, Austin, Texas, United States
  • Han, Dingfen, Johns Hopkins University, Baltimore, Maryland, United States
  • Tuot, Delphine S., University of California, San Francisco, San Francisco, California, United States
  • Jacobs, Elizabeth A., University of Texas Dell Medical School, Austin, Texas, United States
  • Zonderman, Alan B., Intramural Research Program, NIA, NIH, Baltimore, Maryland, United States
  • Evans, Michele Kim, National Institutes of Health/National Institute on Aging, Baltimore, Maryland, United States
  • Crews, Deidra C., Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
Background

Housing insecurity is characterized by high housing costs or unsafe living conditions. Among persons with CKD, we examined whether housing insecurity was associated with postponing medical care.

Methods

We performed a cross-sectional analysis of data from the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study (Baltimore, MD) during study visit 4. We used multivariable log binomial and Poisson regression with robust estimate of variance clustered on neighborhood to quantify associations between housing insecurity (self-report of inability to afford a suitable home or difficulty paying rent/mortgage payments) and self-report of postponing medical care that was felt to be needed among individuals with CKD (eGFR <60 ml/min/1.73m2 or albumin-to-creatinine ratio ≥30 mg/g).

Results

Among 355 HANDLS participants with CKD, 135 (38%) reported housing insecurity. Individuals with housing insecurity were younger (mean [SD] age 57.8 [9.1] years versus 61.1 [8.3] years), more likely to be male (48.9% versus 38.6%), less likely to have a high school degree (60.5% versus 72.3%) and more likely to lack health insurance (6.7% versus 4.1%) than stably housed persons. Overall, 85 (23.9%) participants reported postponing medical care that was felt to be needed. Housing insecurity was associated with increased risk of postponing medical care even after adjusting for demographics, clinical variables, health insurance status, CKD awareness, food insecurity and education level (Table).

Conclusion

Individuals with CKD experiencing housing insecurity may be more likely to postpone medical care, which could increase their risk of poor clinical outcomes.

Association Between Housing Insecurity and Postponement of Medical Care Among People with CKD
Regression ModelIncidence Rate Ratio (95% CI)
Unadjusted1.92 (1.44 – 2.56)
Model 11.73 (1.34 – 2.23)
Model 21.69 (1.34 – 2.15)
Model 31.59 (1.20 – 2.10)

Model 1: adjusted for demographics (age, race, sex, and poverty level). Model 2: adjusted demographics and clinical variables (baseline eGFR, urine albumin-creatinine ratio, blood pressure, and diabetes). Model 3: adjusted for demographics, clinical variables, health insurance, CKD awareness, food insecurity and education level.

Funding

  • Other NIH Support