AHA: Housing status significant risk factor in development of CVD
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The American Heart Association released a scientific statement detailing the many correlations between homelessness, low-quality housing and neighborhood environment with the prevalence of CVD and its risk factors.
“Most studies have primarily examined the associations of residential economic environments with CVD risk and general health,” Mario Sims, PhD, MS, FAHA, professor in the department of medicine at the University of Mississippi Medical Center in Jackson and chair of the writing group for the scientific statement, told Healio. “However, few studies have examined the extent to which dimensions of housing (stability, quality and safety, affordability and accessibility, and neighborhood social and built environment) contribute to CV health or increased CVD that shape inequities between racial/ethnic and socioeconomic groups. This domain of social determinants of health emphasizes the interplay of structural, social, economic and psychosocial factors and their impact on the association of housing with CV health.”
Homelessness and housing insecurity
According to the statement, adults who are homeless may experience up to 70% higher rates of CV events compared with the general population.
This association may be a result of the lack of CV risk factor diagnosis in this population, the inherent barriers to care, medication initiation and adherence and access to healthy foods.
"The disparities in cardiovascular health among people who are homeless and marginally housed are largely due to psychosocial stressors, unhealthy behaviors used as coping mechanisms and barriers to health care, including lack of insurance and stigmatization among this population,” Sims said in a press release.
Nontraditional factors that may contribute to increased risk for CVD among homeless people include the presence of HIV.
The writing group noted that an estimated 25% of homeless adults report recent cocaine use, and this population has an estimated 25% rate of mental illness, which are both factors that can contribute to CVD development and fragmented care.
“Chronic housing insecurity may impact a person’s ability to eat properly, get quality sleep, schedule regular medical care or fill prescriptions due to cost,” Sims said in the release. “These factors all contribute to inadequate treatment to reduce cardiovascular risk factors such as high blood pressure, high cholesterol and tobacco use, and to the greater likelihood of having a cardiovascular event such as a heart attack or stroke.”
Housing quality and neighborhood environment
Although homelessness may be detrimental to CV health, low-quality housing could come with its own risks. Air pollutants such as particulate matter and elemental carbon are associated with CVD and mortality and can be found in homes as a result of biomass, wood, kerosene stoves, tighter building construction or poor air ventilation systems, the writing group stated.
In addition, exposure to secondhand smoke is common among residents of multiunit and public housing. Tobacco smoke can spread via shared ventilation systems, unsealed cracks and door spaces.
According to the Affordable Housing as an Obesity Mediating Environment (AHOME) study referenced by the writing group, public housing residents were more likely to self-report an MI or stroke and to have elevated BP compared with individuals who live in Section 8 housing and those who qualify for but do not receive housing assistance.
“Neighborhood environments are strong predictors of cardiovascular health and well-being,” Sims said in the release. “Studies have consistently shown that individuals residing in economically distressed neighborhoods with high poverty and unemployment rates have a higher incidence of cardiovascular risk factors, including obesity, diabetes, hypertension and heart disease, and higher risk of stroke and death from a cardiovascular disease such as heart attacks, strokes, heart failure and others.”
Individuals residing in economically distressed neighborhoods, with high poverty and unemployment, may experience a greater prevalence of CVD risk factors including obesity, diabetes and hypertension, which confer greater prevalence of CVD events such as CHD and stroke.
The writing group also noted that features that define obesogenic environments such as the density of healthy and unhealthy food retail and walkability may be associated with not only diet and physical activity, but BP, diabetes and metabolic syndrome.
Additionally, the greenness of a community may have a cardioprotective effect, as the authors observed that the presence of plants and vegetation in a neighborhood was associated with lower incidence of type 2 diabetes, acute MI, ischemic heart disease and HF.
“An understanding of these and other dimensions of housing is important for the key stakeholders (health care, community development corporations, private businesses, government) to formulate partnerships that would help to improve housing conditions in the United States, which will reduce and, ultimately, eliminate health inequities in housing,” Sims and colleagues wrote. “Engaging in public policy through voting and advocacy, community networking and population education will be integral in stabilizing the housing crisis.”
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