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Federal Housing Assistance and Chronic Disease Among US Adults, 2005–2018

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This flow chart shows that the analytic cohort started with 39,749 adults (aged ≥20 y) who completed the 2005–2018 NHANES interview; 4,287 were not eligible for linkage and 35,462 were eligible for linkage to 2000–2019 HUD administrative records. Next, 34,175 adults participated in the NHANES examination component; of these, 2,363 were HUD-assisted during or within 5 years before NHANES examination. Among this group, 2,257 had complete data available on their obesity status, 2,150 had complete data on their diabetes status, and 2,172 had complete data on their hypertension status. Of the 34,175 adults, 31,812 were not linked to HUD or not linked to HUD during or within 5 years before NHANES examination. After excluding 2,416 with missing information on income-to-poverty ratio, 29,396 were HUD-unassisted (the overall propensity-score–weighted sample used in the sensitivity analysis); of these, 28,247 had complete data on their obesity status, 27,445 had complete data on their diabetes status, and 27,596 had complete data on their hypertension status. Within this group, there were 13,755 HUD-unassisted with an income-to-poverty ratio <2 (the propensity-score–weighted sample in the main analysis); 13,046 had complete data on their obesity status, 12,662 had complete data on their diabetes status, and 12,689 had complete data on their hypertension status. Finally, 360 adults were classified as future HUD (comparison group in sensitivity analysis), within 5 years after NHANES examination; 338 had complete data on their obesity status; 337 had complete data on their diabetes status; and 334 had complete data on their hypertension status.

Figure 1. Flowchart of analytic sample, 2005–2018. Data source: National Center for Health Statistics, NHANES, 2005–2018, and linked and linked data from HUD, 2000–2019. Abbreviations: HUD, US Department of Housing and Urban Development; IPR, income-to-poverty ratio; NHANES, National Health and Nutrition Examination Survey.

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Figure 2. Linkage-eligible–weighted and propensity-score–weighted prevalence of chronic conditions, by housing assistance status, 2005–2018. Error bars indicate 95% CIs. Data source: National Center for Health Statistics, National Health and Nutrition Examination Survey, 2005–2018, and linked data from HUD, 2000–2019. Abbreviations: HUD, US Department of Housing and Urban Development; IPR, income-to-poverty ratio.

Linkage-eligible–weighted and propensity-score–weighted prevalence of chronic conditions, by housing assistance status, 2005–2018. Error bars indicate 95% CIs. Data source: National Center for Health Statistics, National Health and Nutrition Examination Survey, 2005–2018, and linked data from HUD, 2000–2019. Abbreviations: HUD, US Department of Housing and Urban Development; IPR, income-to-poverty ratio.
Weight % (95% CI)
Condition HUD-assisted HUD-unassisted (IPR <2) Pvalue
Linkage-eligible–weighted Obesity 47.5 (44.8-50.3) 37.9 (36.6-39.1) <.001
Diabetes 17.8 (15.8-19.9) 13.8 (13.0-14.7) .20
Hypertension 48.1 (45.0-51.2) 44.2 (42.7-45.6) .26
Propensity-score–weighted Obesity 47.5 (44.7-50.3) 42.1 (40.4-43.8) <.001
Diabetes 17.8 (15.9-19.9) 16.2 (14.8-17.7) .20
Hypertension 48.1 (45.0-51.2) 50.3 (48.6-52.0) .22

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