Kosaraju Nishad S, Choudhury Tanisha, Stoner Lee, Thomas Aleah L, White Kaitlin E, Andrews Marcus R, Lawrence Briana I, Ormiston Cameron K, Mason Lee, Shiels Meredith S, Ewing Aldenise P, Chen Yingxi, McGee-Avila Jennifer K, Lawrence Wayne R
Edward Via College of Osteopathic Medicine - Carolinas Campus, Spartanburg, SC, USA.
Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA.
Am J Prev Cardiol. 2025 Jun 2;23:101021. doi: 10.1016/j.ajpc.2025.101021. eCollection 2025 Sep.
The proportion of people living in unaffordable housing in the U.S. has grown, and studies have documented a relationship between housing cost burden and poor cardiovascular health. We investigated the association between severe housing cost burden (SHCB) and premature mortality due to cardiovascular disease (CVD) and its subtypes overall and by sex. We further evaluated whether Medicaid expansion status moderated the association between SHCB and premature CVD mortality.
We linked county-level SHCB data from the 2016-2020 American Community Survey with mortality data ascertained from national death certificate data. SHCB was measured as the percentage of households that spend ≥50 % of their income on housing and was categorized into distribution-based quintiles (1=lowest and 5=highest). States were classified based on Medicaid expansion status (expanded, late expanded, non-expanded). Multilevel-linear mixed models, adjusting for confounders, were used to estimate the adjusted rate ratios (aRR) for the association between SHCB and premature CVD mortality.
The highest SHCB quintile, compared to the lowest, had a 15 % higher premature CVD mortality rate (aRR=1.15; 95 %CI 1.06-1.24). Among men, the highest quintile of SHCB had a higher premature mortality rate due to ischemic heart disease (aRR=1.09; 95 %CI 1.01-1.17) and stroke (aRR=1.19; 95 %CI 1.06-1.32) compared with the lowest quintile. Compared to Medicaid expanded states, non-Medicaid expanded states had higher rates of premature CVD mortality for each SHCB quintile (Quintile 5: aRR=1.19; 95 %CI 1.02-1.36).
Our findings suggest counties with greater SHCB, especially if situated within a non-Medicaid expansion state, have higher rates of premature CVD mortality.
美国居住在负担不起住房中的人口比例有所增加，并且研究已经证明住房成本负担与心血管健康状况不佳之间存在关联。我们调查了严重住房成本负担（SHCB）与心血管疾病（CVD）及其亚型导致的过早死亡之间的总体关联以及按性别划分的关联。我们还进一步评估了医疗补助扩大状况是否缓和了SHCB与过早CVD死亡率之间的关联。
我们将2016 - 2020年美国社区调查中的县级SHCB数据与从国家死亡证明数据确定的死亡率数据相链接。SHCB以将≥50%的收入用于住房支出的家庭百分比来衡量，并被分为基于分布的五分位数（1 = 最低，5 = 最高）。各州根据医疗补助扩大状况进行分类（扩大、延迟扩大、未扩大）。使用多水平线性混合模型，并对混杂因素进行调整，以估计SHCB与过早CVD死亡率之间关联的调整率比（aRR）。
与最低五分位数相比，最高SHCB五分位数组的过早CVD死亡率高15%（aRR = 1.15；95%CI 1.06 - 1.24）。在男性中，与最低五分位数相比，最高SHCB五分位数组因缺血性心脏病导致的过早死亡率更高（aRR = 1.09；95%CI 1.01 - 1.17）以及因中风导致的过早死亡率更高（aRR = 1.19；95%CI 1.06 - 1.32）。与医疗补助扩大的州相比，非医疗补助扩大的州在每个SHCB五分位数组中的过早CVD死亡率都更高（五分位数5：aRR = 1.19；95%CI 1.02 - 1.36）。
我们的研究结果表明，SHCB较高的县，特别是位于非医疗补助扩大州的县，过早CVD死亡率更高。
