Drexel Public Health Researchers Lead $3.7 Million Study Looking at Impact of Federal Housing Assistance on Health Care for Chronic Conditions

Drexel Public Health Researchers Lead $3.7 Million Study Looking at Impact of Federal Housing Assistance on Health Care for Chronic Conditions

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Stable housing is associated with positive physical and mental health outcomes and stronger communities. Now Drexel University researchers will explore the role that billions of dollars in federal housing assistance programs have on the use of vital and appropriate medical services and treatments for managing chronic health conditions.

Through a new $3.7 million grant from the National Institutes of Health's National Institute on Nursing Research, the researchers will examine how financial support from the U.S. Department of Housing and Urban Development (HUD) affects access and use of medical treatments, particularly for adults managing chronic health issues.

The findings from this research may help shape programs that designate funding supporting health and safety for millions of people in the United States who rely on HUD for rent funds through public housing, vouchers or other assistance. The data may be particularly relevant to the roughly 150 million Americans living with a chronic health condition and the one million disabled adults in the U.S. who reside in a HUD-assisted household, according to the research team.

Although researchers don't know exactly how many HUD benefit recipients are living with a chronic health issue, nearly three out of four adults in permanent supportive housing experience a mental health and/or substance use disorder and more than a quarter of adults who receive HUD-assistance have obesity.

"We know that HUD serves a critical, sometimes life-saving role in filling housing gaps for people across the United States," said Lindsay Shea, DRPH, an associate professor in the Dornsife School of Public Health and principal investigator on the study. "What we don't know is how federal housing assistance programs from HUD impact access and use of our nation's medical system, including critically important therapies and treatments, especially for adults with chronic health conditions. Better understanding of this can help HUD use funds for maximum health impact."

The implications for the data may be increasingly valuable as the number of adults with chronic health issues in the United States continues to rise - a trend that is expected to continue in years to come. Care for chronic health conditions costs the nation's health care system approximately $1.1 trillion each year - representing 90% of all health care spending in the United States. The figure balloons to $3.7 trillion when factoring in lost economic productivity, according to calculations from the Centers for Disease Control and Prevention.

"Individuals facing housing instability often delay or forgo health and mental health care -including necessary prescriptions - due to cost, contributing to poorer outcomes and exacerbation of chronic health conditions," said Shea. "Housing instability also worsens connectedness to health care, disrupts continuity of care, and increases reliance on emergency departments rather than consistent primary care. These challenges introduce and perpetuate a cycle of poor health and housing instability, but the impact of this has not been quantified in a national sample. Addressing obstacles that limit preventive care and routine management of chronic health conditions are poised to generate health care cost savings."

Using national Medicaid medical claims data from 2016-2023, linked with national HUD data, the team will conduct the most in-depth examination to date of changes to access and use of treatments for common and costly chronic health conditions - including asthma, coronary heart disease, depression and diabetes - in a national sample of adults (ages 21-64) who have newly gained HUD assistance.

The Drexel-based project, which includes collaborators from the University of Pennsylvania and University of North Carolina, will also examine how individual and community factors, such as access to transportation and family support, influence the relationship between housing assistance and access to treatment.

These analyses will be bolstered by data from focus groups with leading housing organizations and interviews with policymakers, subject matter experts and advocates. This process will help researchers to understand perspectives on how housing influences health, identify programs that are being implemented to improve housing and health together and to develop recommendations for data-driven policies and interventions for adults with chronic health conditions who are receiving HUD assistance.

"Our understanding of health is primarily driven by health provider perspectives," said Drexel Research Scientist Anne Roux, MPH, who is leading the qualitative aim of the work. "We need to better understand how housing and housing-related programs can be used to influence health. We want to explore health from the lens of public housing providers and organizations, so we can learn from innovative ideas for addressing health within the context of public housing."

This research is supported by the National Institute of Nursing Research of the National Institutes of Health under Award Number R01NR021977. As with any other NIH-funded research, the content does not necessarily represent the official views of the National Institutes of Health.

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