Housing Wealth and Glycemic Control Among Patients With Type 2 Diabetes

BACKGROUND: Housing wealth can be leveraged to maintain economic security when expenses exceed income, allowing households flexibility when managing a new chronic disease diagnosis. We linked housing and electronic health record (EHR) data to examine how housing wealth and stability relate to type 2 diabetes (T2D) outcomes. METHODS: EHR data from patients diagnosed with T2D were linked to housing data (tenure, foreclosure, home equity, reverse mortgage, and loan-to-value ratio) using residential address. Multinomial logistic regression models were used to estimate associations between housing variables measured in the year before T2D diagnosis and glycemic control a year or more after T2D diagnosis. RESULTS: Among 5810 patients with T2D and complete housing data, patients with more home equity [relative risk ratio (rrr)=0.52, 95% CI: 0.323-0.838, P<0.001] were less likely to experience HbA1c >9% 1 year after diagnosis, and owners who were actively extracting home equity through a reverse mortgage (rrr=2.137, 95% CI: 0.008-1.511, P=0.048) were also more likely to have HbA1c >9% compared with patients with HbA1c<6.5%. Homeowners were less likely than renters to experience HbA1c >9% (rrr=0.798, 95% CI: 0.672-0.948, P=0.010). CONCLUSION: Patients diagnosed with T2D who had more housing wealth were less likely to experience challenges with glycemic control after diagnosis.