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Housing Instability and Incident Hypertension in the CARDIA Cohort

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Abstract

Housing instability, a growing public health problem, may be an independent environmental risk factor for hypertension, but limited prospective data exist. We sought to determine the independent association of housing instability in early adulthood (year 5, 1990–1991) and incident hypertension over the subsequent 15 years of follow-up (years 7, 10, 15, and 20) in the Coronary Artery Risk Development in Young Adults (CARDIA) study (N = 5,115). Because causes of inadequate housing and its effects on health are thought to vary by race and sex, we hypothesized that housing instability would exert a differential effect on incident hypertension by race and sex. At year 5, all CARDIA participants were asked about housing and those free of hypertension were analyzed (N = 4,342). We defined housing instability as living in overcrowded housing, moving frequently, or living doubled up. Of the 4,342 participants, 8.5 % were living in unstable housing. Across all participants, housing instability was not associated with incident hypertension (incidence rate ratio (IRR), 1.1; 95 % CI, 0.9–1.5) after adjusting for demographics, socioeconomic status, substance use, social factors, body mass index, and study site. However, the association varied by race and sex (p value for interaction, <0.001). Unstably housed white women had a hypertension incidence rate 4.7 times (IRR, 4.7; 95 % CI, 2.4–9.2) that of stably housed white women in adjusted analysis. There was no association among white men, black women, or black men. These findings suggest that housing instability may be a more important risk factor among white women, and may act independently or as a marker for other psychosocial stressors (e.g., stress from intimate partner violence) leading to development of hypertension. Studies that examine the role of these psychosocial stressors in development of hypertension risk among unstably housed white women are needed.

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Acknowledgments

Dr. Vijayaraghavan was supported by the Department of Health and Human Services-Health Resources and Services Administration, Primary Care Research Fellowship grant (D55HP05165) at the University of California, San Francisco. Dr. Vijayaraghavan is currently supported by a post-doctoral fellowship at the Cancer Prevention and Control Program, Moores Cancer Center at the University of California, San Diego. Dr. Bibbins-Domingo was supported by grants from the Robert Wood Johnson Amos Faculty Development Program, a diversity supplement to the CARDIA study contract to the University of Alabama Coordinating Center (grant N01-HC-95095), and by a UCSF Hellman Family Faculty Award. Preliminary results from this study were presented at the UCSF Health Disparities Research Symposium, 22 October 2010, and the Annual Society of General Internal Medicine Conference, 4–7 May 2011. The authors would like to thank Tekeshe Mekonnen, MS, for providing administrative assistance in the submission of the manuscript.

Financial Sources

Work on this manuscript was supported (or partially supported) by contracts: University of Alabama at Birmingham, Coordinating Center, N01-HC-95095; University of Alabama at Birmingham, Field Center, N01-HC-48047; University of Minnesota, Field Center and Diet Reading Center (Year 20 Exam), N01-HC-48048; Northwestern University, Field Center, N01-HC-48049; Kaiser Foundation Research Institute, N01-HC-48050; University of California, Irvine, Echocardiography Reading Center (Year 5 and 10), N01-HC-45134; Harbor-UCLA Research Education Institute, Computed Tomography Reading Center (Year 15 Exam), N01-HC-05187; Wake Forest University (Year 20 Exam), N01-HC-45205; New England Medical Center (Year 20 Exam), N01-HC-45204 from the National Heart, Lung and Blood Institute. The funding organizations had no role in the design and conduct of the study.

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Authors and Affiliations

  1. Division of General Internal Medicine, San Francisco General Hospital, San Francisco, CA, USA

    M. Vijayaraghavan, M. B. Kushel & K. Bibbins-Domingo

  2. University of California, San Francisco, San Francisco, CA, USA

    M. Vijayaraghavan, M. B. Kushel, E. Vittinghoff & K. Bibbins-Domingo

  3. UCSF Department of Epidemiology and Biostatistics, San Francisco, CA, USA

    E. Vittinghoff & K. Bibbins-Domingo

  4. Center for Surgical, Medical and Acute Care Research and Transitions, Birmingham VA, Medical Center, Birmingham, AL, USA

    S. Kertesz

  5. Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, USA

    S. Kertesz & C. E. Lewis

  6. Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis, MS, USA

    D. Jacobs

  7. Kaiser Permanente, Northern California Division of Research, Oakland, CA, USA

    S. Sidney

  8. Medicine and of Epidemiology and Biostatistics, Division of General Internal Medicine, University of California, San Francisco, San Francisco, CA, USA

    K. Bibbins-Domingo

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  1. M. Vijayaraghavan
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  2. M. B. Kushel
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Correspondence to K. Bibbins-Domingo.

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Vijayaraghavan, M., Kushel, M.B., Vittinghoff, E. et al. Housing Instability and Incident Hypertension in the CARDIA Cohort. J Urban Health 90, 427–441 (2013). https://doi.org/10.1007/s11524-012-9729-z

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