Abstract 4140037: The association of housing unaffordability with medication adherence and health outcomes among non-elderly adult Medicaid beneficiaries with atherosclerotic cardiovascular disease

Background: The burden of housing costs is at an all-time high in the United States. Individuals with lower socioeconomic status experience worse health outcomes and are also disproportionately impacted by housing costs. Whether housing unaffordability is independently associated with medication adherence or health outcomes in individuals with cardiovascular (CV) disease is not well studied. Methods: All 19- to 64-year-old Medicaid beneficiaries in the United States with atherosclerotic CV disease (ASCVD) – coronary artery disease, peripheral arterial disease, and cerebrovascular disease/stroke – in 2018 were identified using Medicaid administrative claims data. The study population was limited to people continuously enrolled in 2019 and excluded Medicare-Medicaid dual enrolled beneficiaries. Medication adherence to Statin therapy and the number of all-cause and CV emergency department (ED) visits and hospitalizations were assessed in 2019. ZIP code level housing cost burden was measured as the proportion of all residents who spent more than 30% of their income on housing costs and was obtained from the 2015-2019 American Community Survey. Negative binomial generalized estimating equation (GEE) models were fit to account for the hierarchical nature of the data and were adjusted for individual demographic and clinical variables and area-level measures of socioeconomic status and social vulnerability. Results: A total of 443,984 beneficiaries with ASCVD living in 24,349 ZIP codes were identified. The mean ZIP-code level proportion of residents with unaffordable housing was 33.5% (SD=6.3%). In the multivariable GEE models, a 1 percentage point increase in the proportion of residents with unaffordable housing was associated with 0.05% (95% CI 0.01% to 0.1%) lower adherence to Statin therapy. It was also associated with a 0.6% (95% CI 0.3% to 0.8%) increase in the number of CV ED visits and a 0.3% (95% CI 0.04% to 0.5%) increase in CV hospitalizations. Housing unaffordability was also associated with a significant increase in all-cause ED visits [0.4% (95% CI 0.2% to 0.5%)]. Conclusion: Among non-elderly adult Medicaid beneficiaries with ASCVD, residence in a ZIP code with higher levels of housing unaffordability was independently associated with lower medication adherence to Statin therapy and a higher number of CV ED visits and hospitalizations. Whether improving housing affordability among this population can improve CV health outcomes needs to be studied further.