The effects of affordable housing access on type 2 diabetes self-management and control

项目摘要 美国低收入租房者面临严重的经济适用房危机，可能对人口产生不利影响 健康目前的经济适用房短缺可能会对未来产生特别重大的影响。 患有行为控制慢性疾病的成年人的健康，如2型糖尿病。2型糖尿病 需要复杂且资源密集型的日常管理，对社会条件高度敏感，例如 住房此外，2型糖尿病和糖尿病相关并发症的患病率上升， 低收入成年人和少数民族不平等地承担;两个人口面临更大的住房风险 挑战由美国住房和城市发展部（HUD）提供的租金援助是一项 低收入家庭负担得起的住房的主要来源。但由于供应限制， 每四个符合条件的家庭中就有一个以上获得这种资源，全国平均等待时间为26个月。获得 租金援助可以通过降低住房成本来改善糖尿病自我管理和控制， 与糖尿病相关费用竞争，并提供稳定性，使个人能够建立和 保持一贯的自我管理程序。此外，未满足的租房援助需求造成了 通过严格的方法研究经济适用房对健康的影响的独特机会， 比较等候名单和租金援助的个人。本研究的主要目的是评估 提供糖尿病自我管理和控制的生物和行为指标方面的租金援助， 研究这些影响发生的过程。我们的项目有三个目标：1）估计 使用HUD的独特联系，租金援助对2型糖尿病自我管理和控制的影响 行政数据和全国代表性健康调查。2)为了研究如何从租赁过渡到 援助等待名单进入租金援助住房与糖尿病自我管理的变化有关 2型糖尿病患者的纵向队列研究3）为了研究等待治疗的经历如何影响2型糖尿病患者的生活质量， 和获得租金援助塑造糖尿病的行为和结果，使用定性访谈进行 目标2参与者的子样本。调查结果将告知是否以及如何提供租金援助和其他 可利用住房干预措施来改善糖尿病治疗结果，减少糖尿病差异。 此外，通过确定将住房与健康联系起来的过程，研究结果将为临床和 行为干预，以改善糖尿病的结果，为居住不足的成年人，即使在没有 扩大住房准入。除了糖尿病，研究结果将作为理解关系的模型 经济适用房和慢性病管理行为之间的关系。

Project Abstract Low-income US renters face a severe affordable housing crisis that likely has adverse effects on population health. The current affordable housing shortage is likely to have particularly significant implications for the health of adults living with behaviorally managed chronic conditions such as type 2 diabetes. Type 2 diabetes requires complex and resource intensive daily management that is highly sensitive to social conditions such as housing. Furthermore, the rising prevalence of type 2 diabetes and diabetes related complications are unequally borne by low-income adults and racial minorities; two populations that are at greater risk of housing challenges. Rental assistance, provided by the US Department of Housing and Urban Development (HUD) is a primary source of affordable housing for low-income households. However, due to supply constraints, fewer than 1 in 4 eligible households receive this resource and waiting lists average 26 months nationally. Access to rental assistance may improve diabetes self-management and control by reducing housing costs that can compete with diabetes-related expenses and by providing stability that allows individuals to establish and maintain consistent self-management routines. Furthermore, the unmet need for rental assistance creates a unique opportunity to study the effects of affordable housing on health through rigorous approaches that compare waitlisted and rent-assisted individuals. The primary goals of this study are to estimate the effects of rental assistance on biological and behavioral indicators of diabetes self-management and control, and to examine the processes through which these effects occur. Our project has three aims: 1) To estimate the effects of rental assistance on type 2 diabetes self-management and control using a unique linkage of HUD administrative data and a nationally representative health survey. 2) To examine how transitions from rental assistance waiting lists into rent-assisted housing are associated with changes in diabetes self-management and control in a longitudinal cohort of adults with type 2 diabetes 3) To examine how experiences of waiting for and obtaining rental assistance shape diabetes behaviors and outcomes using qualitative interviews conducted with a sub-sample of aim 2 participants. Findings will inform whether and how rental assistance and other housing interventions can be leveraged to improve diabetes outcomes and to reduce diabetes disparities. Furthermore, by identifying processes that connect housing to health, findings will inform clinical and behavioral interventions to improve diabetes outcomes for inadequately housed adults, even in the absence of expanded housing access. Beyond diabetes, findings will serve as a model for understanding relationships between affordable housing access and chronic disease management behaviors more broadly.