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负担得起的住房危机，这可能会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 患有行为管理的慢性疾病(如2型糖尿病)的成年人的健康。2型糖尿病 需要对社会状况高度敏感的复杂且资源密集型的日常管理 住房。此外，2型糖尿病和糖尿病相关并发症的发病率不断上升 由低收入成年人和少数族裔承担的不平等；两个面临更大住房风险的人群 挑战。由美国住房和城市发展部(HUD)提供的租赁援助是 低收入家庭负担得起的住房的主要来源。然而，由于供应限制，较少 每4个符合条件的家庭中就有1个获得这一资源，全国平均有26个月的等待名单。进入 租金援助可以通过降低住房成本来改善糖尿病的自我管理和控制，这可以 与糖尿病相关的费用竞争，并通过提供稳定性，允许个人建立和 保持一致的自我管理程序。此外，对租赁援助的未得到满足的需求造成了 通过严谨的方法研究经济适用房对健康的影响的独特机会 比较一下等候名单和房租援助的个人。这项研究的主要目标是评估 在糖尿病自我管理和控制的生物和行为指标方面提供租金援助，并 考察这些影响发生的过程。我们的项目有三个目标：1)评估 使用HUD独特连锁的租赁援助对2型糖尿病自我管理和控制的影响 行政数据和具有全国代表性的健康调查。2)研究如何从租赁过渡 进入租金援助住房的援助等待名单与糖尿病自我管理的变化有关 并在成人2型糖尿病纵向队列中进行对照3)以检查等待的经历如何 通过进行定性访谈，获得租赁帮助塑造糖尿病行为和结局 包括目标2参与者的一个子样本。调查结果将告知是否以及如何提供租赁援助和其他 可以利用住房干预措施来改善糖尿病结果并减少糖尿病差异。 此外，通过确定将住房与健康联系起来的过程，研究结果将向临床和 行为干预以改善居住条件不佳的成年人的糖尿病结局，即使在没有 扩大住房准入。除了糖尿病，研究结果还将成为理解人际关系的模型 在更广泛的范围内，提供经济适用住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.