Housing status, mortgage debt and financial burden as barriers to health among older adults in the U.S

ABSTRACT

We examine relations between housing status, mortgage, financial burden, and healthy aging among older U.S. adults. We combine cross-sectional data from 2012 to 2014 Health and Retirement Study cohorts. Using regression models, we examined associations between owners and renters, mortgage and non-mortgage holders, financial strain, and difficulty paying bills, and poor self-rated health (SRH), heart condition (HC) and hospitalization (past two years). We find that compared to owners, renters had greater likelihood of poor SRH and hospitalization. Regardless of tenure, financial strain was associated with greater likelihood of poor SRH, HC and hospitalization, while difficulty paying bills was associated with poor SRH and HC. Mortgage holders had lower likelihood of poor SRH. Accounting for mortgage status, financial strain was associated with greater likelihood of poor SRH, HC and hospitalization, while difficulty paying bills was associated with poor SRH and HC. Associations between tenure or mortgage status and health were not modified by either financial burden factors. We conclude that there need to be more robust and inclusive programs that assist older populations with housing could improve self-rated health, with particular attention to renters, mortgage holders and those experiencing financial burden.

KEYWORDS:

• housing
• mortgage
• health
• housing tenure
• older population

Acknowledgments

This study was supported by a pilot grant from the Michigan Center on the Demography of Aging (P30-AG012846). The National Institute on Aging provides funding for the Health and Retirement Study (U01 AG 009740), which is performed at the Institute for Social Research, University of Michigan. The authors would also like to thank Ryan McCammon and Mohammed Kabeto for their guidance on using the HRS dataset, Josh Erickson for his advice on the statistical analysis and the peer-reviewers for their thoughtful feedback.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported by the Michigan Center on the Demography of Aging [P30-AG012846].

Notes on contributors

Roshanak Mehdipanah

Dr. Roshanak Mehdipanah PhD is an Assistant Professor in the Department of Health Behavior and Health Education in the School of Public Health. Dr. Mehdipanah has led several projects on housing and health including evaluations of existing housing policies and their impacts on health inequities. She has also examined associations between neighborhood characteristics and housing discrimination in the Detroit Metropolitan Area. She specializes in innovative research methods including realist evaluations and concept mapping to develop conceptual frameworks linking complex interventions to health. Dr. Mehdipanah's current research portfolio focuses on various aspects of urban health including urban renewal, design, housing, and gentrification.

Jaclyn Martin

Jaclyn Martin MPH is a project manager on the Advancing Health Equity: Leading Care, Payment, and Systems Transformation initiative housed at the University of Chicago and funded by the Robert Wood Johnson Foundation. She holds a master's degree in public health from the Department of Health Behavior and Health Education in the School of Public Health at the University of Michigan. Her education focused on the impact of social policies on health inequities. She worked on this project with Dr. Mehdipanah and the rest of the team while completing her MPH.

Alexa K. Eisenberg

Alexa K. Eisenberg MPH is a doctoral candidate in the Department of Health Behavior and Health Education at the School of Public Health and a National Institute of Health trainee at the Population Studies Center at the University of Michigan. Their researchintegrates methods from demography, social geography, and legal epidemiology to understand how housing and urban policies reproduce racialized hierarchies in population health in US metropolitan areas. Alexa is involved with several evaluation studies that focus on property tax foreclosure and eviction prevention in Detroit, Michigan.

Amy J. Schulz

Dr.Amy J. Schulz PhD is University Diversity and Social Transformation Professor in the Department of Health Behavior and Health Education at the University of Michigan School of Public Health. Her research focuses on social factors that contribute to health with a particular focus on social and physical environmental conditions and their effects on health and health equity with a focus on urban health. A majority of Dr. Schulz's research is conducted with partners in Detroit, using a community-based participatory research approach. She has been involved in working with Detroit partners to understand and address factors that contribute to excess risk of cardiovascular disease in Detroit, conduct health impact assessments of proposed policies, and develop public health action plans to reduce air pollution and promote health in Detroit and the surrounding area.

Lewis B. Morgenstern

Dr. Lewis B. Morgenstern MDis professor of neurology, emergency medicine and neurosurgery at the University of Michigan Medical School. He also is professor of epidemiology in the Center for Social Epidemiology and Population Health at the UM School of Public Health. Dr. Morgenstern is a National Institutes of Health-funded principal investigator of studies that aim to reduce stroke and cognitive health disparities with respect to race, ethnicity, and gender. His other research focus is the treatment of intracerebral hemorrhage and mobilizing health care professionals and communities to treat acute ischemic stroke. He is currently principal investigator of five NIH R01 grants.

Kenneth M. Langa

Dr. Kenneth M. Langa MD PhD is the Cyrus Sturgis Professor in the Department of Internal Medicine and Institute for Social Research, a Research Scientist in the Veterans Affairs Center for Clinical Management Research, and an Associate Director of the Institute of Gerontology, all at the University of Michigan. He is also Associate Director of the Health and Retirement Study (HRS), a National Institute on Aging funded longitudinal study of 20,000 adults in the United States. He is a General Internist with an active clinical practice treating adult patients, an elected member of the American Society for Clinical Investigation (ASCI), and an elected fellow of the American Association for the Advancement of Science (AAAS).