Association Between Rental Assistance Programs and Undiagnosed Diabetes Among U.S

Carolina Gonzalez-Lopez; Andrew Fenelon; Kasia J Lipska; Whitney Denary; Penelope Schlesinger; Denise Esserman; Danya Keene

doi:10.1007/s11606-024-08673-2

Association Between Rental Assistance Programs and Undiagnosed Diabetes Among U.S

J Gen Intern Med. 2024 Feb 13. doi: 10.1007/s11606-024-08673-2. Online ahead of print.

Authors

Carolina Gonzalez-Lopez^{1

2}, Andrew Fenelon³, Kasia J Lipska⁴, Whitney Denary⁵, Penelope Schlesinger⁵, Denise Esserman⁶, Danya Keene⁵

Affiliations

¹ Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA. Carolina.gonzalez-lopez@yale.edu.
² Section of Endocrinology, Yale University, 333 Cedar Street, P.O. Box 208020, New Haven, CT, 06520, USA. Carolina.gonzalez-lopez@yale.edu.
³ School of Public Health, University of Minnesota-Twin Cities, Minneapolis, MN, USA.
⁴ Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA.
⁵ Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA.
⁶ Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA.

PMID: 38351417
DOI: 10.1007/s11606-024-08673-2

Abstract

Background: Rental assistance programs have been linked to better housing quality, stability, healthcare access, and reduced likelihood of uncontrolled diabetes. However, its direct association with diabetes screening is uncertain.

Objective: To determine whether federal rental assistance programs are associated with lower odds of undiagnosed diabetes.

Design: We used a quasi-experimental approach, comparing outcomes among adults receiving rental assistance to those who entered assisted housing within 2 years after their health data were collected. We test the a priori hypothesis that rental assistance will be associated with decreased odds of undiagnosed diabetes.

Participants: Participants in the National Health and Nutrition Examination Survey 1999-2018 who received rental assistance and who had diabetes.

Intervention: Current rental assistance participation, including specific housing programs.

Main measures: Undiagnosed diabetes based on having hemoglobin A1c ≥ 6.5% but answering no to the survey question of being diagnosed with diabetes.

Key results: Among 435 eligible adults (median age 54.5 years, female 68.5%, non-Hispanic white 32.5%), 80.7% were receiving rental assistance programs at the time of the interview, and 19.3% went on to receive rental assistance within 2 years. The rates of undiagnosed diabetes were 15.0% and 25.3% among those receiving rental assistance programs vs. those in the future assistance group (p-value = 0.07). In an adjusted logistic regression model, adults receiving rental assistance had lower odds of undiagnosed diabetes (OR 0.52, 95% CI 0.28-0.94) than those in future assistance groups. Sex, race and ethnic group, educational level, and poverty ratio were not significantly associated with having undiagnosed diabetes, but individuals aged 45-64 years had significantly lower odds of undiagnosed diabetes (OR 0.21, 95% CI 0.08-0.53) compared with those aged 18-44.

Conclusions: Rental assistance was linked to lower odds of undiagnosed diabetes, suggesting that affordable housing programs can aid in early recognition and diagnosis, which may improve long-term outcomes.

Keywords: Diabetes; Housing instability; Rental assistance.

Abstract

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