Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts, USA.
Department of Environmental and Occupational Health, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia, USA.
Environ Health Perspect. 2024 Mar;132(3):37004. doi: 10.1289/EHP12645. Epub 2024 Mar 13.
Federal housing assistance is an important policy tool to ensure housing security for low-income households. Less is known about its impact on residential environmental exposures, particularly lead.
We conducted a quasi-experimental study to investigate the association between federal housing assistance and blood lead levels (BLLs) in a nationally representative US sample age 6 y and older eligible for housing assistance.
We used the 1999-2018 National Health and Nutrition Examination Survey (NHANES) linked with US Department of Housing and Urban Development (HUD) administrative records to assess BLLs of NHANES participants with concurrent HUD housing assistance (i.e., current recipients, ) and those receiving assistance within 2 y after the survey (i.e., pseudo-waitlist recipients, ). We estimated BLL least squares geometric means (LSGMs), odds ratio (OR) for BLL , and percent differences in LSGMs by HUD housing assistance status adjusting for age, sex, family income-to-poverty ratio, education, country of birth, race/ethnicity, region, and survey year. We also examined effect modification using interaction terms and stratified analyses by program type [i.e., public housing, multifamily, housing choice vouchers (HCV)], and race/ethnicity.
Current HUD recipients had a significantly lower LSGM [; 95% confidence interval (CI): 1.02, 1.12] than pseudo-waitlist recipients (; 95% CI: 1.14, 1.28), with an adjusted OR of 0.60 (95% CI: 0.42, 0.87) for BLL . Some effect modification were observed: The protective association of HUD assistance on BLL was strongest among public housing ( LSGM; 95% CI: , ), multifamily ( LSGM; 95% CI: , ), and non-Hispanic White ( LSGM; 95% CI: , ) recipients. It was weaker to null among HCV ( LSGM; 95% CI: , 1.7%), non-Hispanic Black ( LSGM; 95% CI: , 5.4%), and Mexican American (-12.5% LSGM; 95% CI: , ) recipients.
Our research underscores the importance of social-structural determinants like federal housing assistance in providing affordable, stable, and healthy housing to very low-income households. More attention is needed to ensure housing quality and racial equity across HUD's three major housing assistance programs. https://doi.org/10.1289/EHP12645.
联邦住房援助是确保低收入家庭住房安全的一项重要政策工具。对于其对住宅环境暴露，尤其是铅的影响，人们知之甚少。
我们进行了一项准实验研究，以调查全国代表性的美国样本中联邦住房援助与血铅水平（BLL）之间的关联，该样本年龄在 6 岁及以上，有资格获得住房援助。
我们使用了 1999 年至 2018 年全国健康和营养检查调查（NHANES）与美国住房和城市发展部（HUD）行政记录的链接，以评估同时接受 NHANES 参与者的 HUD 住房援助（即当前受助人）和在调查后 2 年内接受援助的参与者的 BLL（即假候补受助人）。我们估计了 HUD 住房援助状态下 BLL 的最小二乘几何平均值（LSGM）、BLL 的比值比（OR）以及 LSGM 的百分比差异，调整了年龄、性别、家庭收入与贫困比例、教育、出生国、种族/族裔、地区和调查年份等因素。我们还使用交互项和按计划类型（即公共住房、多户家庭、住房选择券[HCV]）和种族/族裔进行分层分析来检验效应修饰。
当前 HUD 受助人的 LSGM 明显低于候补受助人（；95%置信区间[CI]：1.02，1.12），BLL 的调整比值比（OR）为 0.60（95%CI：0.42，0.87）。观察到一些效应修饰：HUD 援助对 BLL 的保护作用在公共住房（LSGM；95%CI：，）、多户家庭（LSGM；95%CI：，）和非西班牙裔白人（LSGM；95%CI：，）受助人中最强。在 HCV（LSGM；95%CI：，1.7%）、非西班牙裔黑人（LSGM；95%CI：，5.4%）和墨西哥裔美国人（-12.5%LSGM；95%CI：，）受助人中较弱至无效。
我们的研究强调了联邦住房援助等社会结构决定因素在为非常低收入家庭提供负担得起、稳定和健康的住房方面的重要性。需要更加关注确保 HUD 的三个主要住房援助计划中的住房质量和种族公平。https://doi.org/10.1289/EHP12645.
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