Background: The aim of this analysis was to examine the influence that housing insecurity has on diabetes care.

Methods: Using nationally representative data from 2014 and 2015 Behavioral Risk Factor Surveillance System (BRFSS), we investigated 16,091 individuals, representing over 7 million adults with diabetes in the U.S. Housing insecurity defined as how often in the past 12 months respondents reported being worried or stressed about having enough money to pay your rent/mortgage; responses of sometimes/often/always were categorized as housing insecure. Unadjusted logistic models for the relationship of housing insecurity on diabetes self-care and quality of care were followed by tests for interaction between housing insecurity and either race/ethnicity or employment. Stratified models were adjusted for age, gender, race/ethnicity, education, marital status, employment status, household income, insurance, and comorbidity count.

Results: 38.1% of adults with diabetes reported housing insecurity. Significant interactions existed between housing insecurity and employment on the relationship with seeing a doctor or checking A1c. Significant interactions existed between housing insecurity and race/ethnicity on having an eye exam in the past 12 months or completing physical activity in the past month. Individuals who were employed who reported housing insecurity had a lower likelihood of seeing a doctor in the past 12 months (0.58, 95% CI 0.37, 0.92) and having their A1c checked (0.45, 95% CI 0.26, 0.79). Non-Hispanic blacks who reported housing insecurity had a lower likelihood of having an eye exam (0.67, 95% CI 0.54, 0.83) or being physically active (0.81, 95% CI 0.69, 0.96).

Conclusion: Housing insecurity had an influence on diabetes care and self-care behaviors. For those who were employed, seeing a doctor and checking A1c was still negatively associated with housing insecurity. Diabetes care interventions should include a focus on housing insecurity as it has an impact on diabetes care.


E. Mosley-Johnson: None. R.J. Walker: None. H.L. Prigmore: None. L.E. Egede: Consultant; Self; Novo Nordisk Inc. Research Support; Self; National Institute of Diabetes and Digestive and Kidney Diseases.


National Institutes of Health

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