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Association Between Rental Assistance Programs and Undiagnosed Diabetes Among U.S
Carolina Gonzalez-Lopez1,2, Andrew Fenelon3, Kasia J Lipska4
1Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA. Carolina.gonzalez-lopez@yale.edu.
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.
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