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Introduction: Housing instability may be an important determinant contributing to cardiometabolic health. However, studies have focused largely on urban contexts. Further, there may be race- and sex-related differences in housing instability, which may help explain racial and sex disparities in cardiometabolic health. We examined the association between housing instability and cardiometabolic health among rural adults and analyzed potential race and sex differences. Methods: Data are from the Risk Underlying Rural Areas Longitudinal subcohort (mean SD age, 48.8 11.0 years; 70.1% women; 79.8% Black) sampled in two rural Counties in Alabama (n=903). Housing stability (range: 0-10) was defined using the Rollins Index with higher scores indicating greater housing instability. We examined multiple measures of cardiometabolic health including BMI, HDL and LDL cholesterol, triglycerides, current smoking status (yes/no), and coronary artery calcification (CAC > 0). Multivariable linear and logistic regression models adjusted for age, education, and income were used to examine continuous and categorical measures of cardiometabolic health, respectively. We further examined differences by self-reported race and sex in the association between housing instability and cardiometabolic health. Results: In the overall sample, mean (SD) housing instability was 1.1 (1.6). The prevalence of housing instability (Rollins Index ≥ 1) was higher for Black participants compared to White participants (60.5% vs. 27.4%, p<.0001). Housing instability did not differ by sex (52.9% women vs. 57.4% men, p=0.187). In multivariable-adjusted models, greater housing instability was associated with presence of CAC among Black participants (OR 1.12; 95% CI: 1.00, 1.26) but with lower prevalence of CAC among White participants (OR 0.49; 95% CI: 0.25, 0.90). Housing instability was also associated with higher HDL cholesterol levels (b=1.04; 95% CI: 0.08, 2.01) among Black participants and higher triglyceride levels among White participants (b=29.40; 95% CI: 0.49, 58.31). Housing instability was not associated with BMI in either group and was associated with higher prevalence of current smoking among Black participants only (OR 1.20; 95% CI: 1.07, 1.34). We did not observe statistically significant associations between housing instability and cardiometabolic health in sex-stratified analyses. Conclusion: Housing instability may be a social determinant of cardiometabolic health; however, findings were mixed and appear to vary for Black adults compared to White adults. Future research should utilize a longitudinal design to assess how changes in housing stability may affect cardiometabolic health over time.
Fields et al. (Tue,) studied this question.