Rental assistance impacts on diabetes: Insights from a longitudinal mixed-methods analysis

The U.S. faces a persistent shortage of affordable housing, forcing many low-income individuals with chronic illnesses such as diabetes to navigate trade-offs between housing, healthcare, and basic needs essential for disease management. Rental assistance may alleviate these pressures by increasing housing stability, reducing financial strain, and enabling safer medication storage and food preparation. However, only a fraction of eligible households receive assistance, and long waitlists create a natural comparison group for examining health impacts. This mixed-methods, two-and-a-half-year longitudinal study utilizes data from the Blinded Study, which followed 113 adults with diabetes who were on a waitlist for rental assistance in Connecticut at baseline. Using a linear mixed-effects model, we examined within-person changes in glycemic control (HbA1c) as participants transitioned into rental assistance. We did not observe a significant difference in changes in HbA1c between those who obtained rental assistance vs. those who did not across follow-ups. Qualitative interviews with a subsample of 30 participants revealed substantial heterogeneity in experiences of transitioning from waitlists to rental assistance, which may help explain these null findings. For some participants, rental assistance supported diabetes management by preserving or improving access to medical care and increasing autonomy in day-to-day diabetes management. For others, diabetes management was hindered by disrupted medical care after relocation or by inadequate kitchen conditions, including lack of refrigeration, stoves, or pest-free environments. These findings suggest that efforts to improve health through rental assistance may require complementary attention to housing quality, residential stability, and continuity of medical care.