They say home is where the heart is. But it seems having a home and certain housing conditions can affect an individual’s risk for heart disease, according to a new scientific statement from the American Heart Association published in
Circulation: Cardiovascular Quality and Outcomes. The report calls attention to gaps in research about the ways housing can influence cardiovascular health. It also underscores the need to consider these factors in efforts to improve care and eliminate health inequities.
Obesity, inactive lifestyles, diabetes, and high cholesterol are well known heart risk factors. Far less understood are the ways in which where we live can help set the stage for—or help prevent—heart disease. This statement reviews research published in the past 20 years involving how four aspects of housing may affect cardiovascular health: stability, quality and safety, affordability and accessibility, and the neighborhood’s physical and social environment.
For example, people who are homeless are much more likely to suffer cardiovascular events, such as heart attacks, strokes, and heart failure. Data suggest that rates of these events are 60%-70% higher in homeless adults compared with the general population. This trend may be explained, in part, by more frequent smoking, cocaine use, fragmented access to care, untreated risk factors for cardiovascular disease, as well as other stressors (for example, the stress of finding nightly shelter and food), and a higher burden of anxiety and mental illness overall.
In addition, those who have trouble finding permanent housing, who move often, or feel forced out of their homes due to new community development—which often raises rents and home prices—are more likely to have high blood pressure, stroke and heart failure. Research also shows an association between foreclosures and poorer cardiovascular health with notable differences among people of different racial and ethnic backgrounds. On the other hand, it seems feeling secure about one’s housing may be protective.
Still, even among those with a permanent home, certain housing environments are linked to a higher risk of heart disease or stroke. Examples include living in spaces with substandard conditions, such as poor ventilation, exposure to mold, lead or secondhand smoke, poor heating or air conditioning, or crowding. Other neighborhood factors also can affect heart health, for example being close to highways and other sources of pollution, lack of safe spaces to walk, or not having easy access to grocery stores with healthy food options or pharmacies to fill prescription medications.
In their conclusion, the authors write, “We recognize that housing conditions may be a direct driver of cardiovascular health and well-being, as well as being intermediate in the pathway between upstream social and economic disadvantages and downstream cardiovascular health outcomes.” They go on to reinforce that “Efforts to reduce and eliminate health disparities should promote and consider multilevel housing interventions, particularly for vulnerable and underserved populations.”
Future work should include more data on the impact of rural housing on cardiovascular outcomes. In addition, studies are needed to assess how community initiatives and equitable housing opportunities may improve health, and to establish best practices and collaborative models that engage a variety of community leaders.