Housing Cost Linked to Worse Health Outcomes in Medicaid Patients With Heart Failure

Rising housing costs may be more than a financial strain—they could be a health risk for low-income adults with heart failure. A new study found that a higher area-level housing cost burden was associated with increased odds of cardiovascular-related hospitalizations and emergency department (ED) visits.

The findings suggest that addressing housing affordability could play a role in improving outcomes for vulnerable patients with chronic cardiovascular disease.

This cross-sectional study is published in JAMA Health Forum.

“A high proportion of individuals with a high housing cost burden in an area may therefore be helpful for identifying communities where residents are especially vulnerable to disease exacerbations requiring greater resource investment, independent of other area-level factors,” wrote the researchers of the study.

Social determinants of health—like income, education, neighborhood environment, and access to care—are increasingly recognized as key drivers of outcomes in cardiovascular disease, including heart failure, with disadvantaged patients experiencing higher risks of hospitalization, progression, and mortality due to nonmedical factors that shape access, adherence, and overall health resilience.²

This study analyzed individual-level health care utilization data from the 2018–2019 Transformed Medicaid Statistical Information System Analytic Files, including 233,195 Medicaid beneficiaries aged 19 to 64 years with a preexisting diagnosis of heart failure, residing in 19,577 US zip codes (excluding Alabama, Rhode Island, and Utah due to data limitations).

Area-level housing cost burden was defined as the proportion of households with annual income under $35,000 spending 30% or more on housing. Generalized estimating equation models assessed associations between housing cost burden and the probability of cardiovascular-related hospitalizations or ED visits, adjusting for individual and area-level covariates.

Among the beneficiaries studied (mean [SD] age 51.5 [9.6] years; 46.1% female), the mean zip code–level housing cost burden was 67.4% (16.5%). In 2019, 18.4% of beneficiaries experienced at least 1 cardiovascular-related hospitalization, and 32.3% had an ED visit. After adjusting for individual and area-level factors, each 10–percentage point increase in housing cost burden was associated with higher odds of cardiovascular hospitalizations (OR, 1.03; 95% CI, 1.01-1.06), ED visits (OR, 1.03; 95% CI, 1.01-1.04), and heart failure–specific hospitalizations (OR, 1.04; 95% CI, 1.01-1.07), indicating a significant relationship between housing affordability and adverse health outcomes.

This study has several limitations. Beneficiaries who disenrolled from Medicaid or died during the study period were excluded, preventing analysis of housing cost burden in relation to mortality or outcomes among those without continuous enrollment. Zip codes served as a proxy for neighborhoods, but they vary widely in size and boundaries, and unmeasured confounding remains possible. Data on government housing assistance, reasons for moving, and Medicare–Medicaid dual enrollment were not fully captured, and the cross-sectional design precludes causal inference.

Despite these limitations, the researchers believe the study findings suggest that a higher area-level housing cost burden is associated with increased cardiovascular-related hospitalizations and ED visits among Medicaid beneficiaries with heart failure.

Addressing housing affordability may represent an important strategy to improve health outcomes in this vulnerable population. Future research should explore interventions targeting housing stress and evaluate their potential to reduce adverse cardiovascular events and health care utilization.

“In this cross-sectional study of adult Medicaid beneficiaries aged 19 to 64 years with HF [heart failure], residing in a zip code with a high housing cost burden was associated with increased odds of CV [cardiovascular]-related hospitalizations and ED visits,” wrote the researchers. “With rising costs of housing in the US, this study highlights the need to investigate whether strategies to improve affordability can play a role in improving health outcomes for individuals with lower income and HF.”

References

1. Ceasar JN, Yang L, Eberly LA, et al. Housing cost burden and outcomes among Medicaid beneficiaries with heart failure. JAMA Health Forum. 2026;7(1):e255903. doi:10.1001/jamahealthforum.2025.5903

2. McCrear S. Social determinants of health linked to worse outcomes in hypertrophic cardiomyopathy. AJMC®. January 7, 2026. Accessed February 27, 2026. https://www.ajmc.com/view/social-determinants-of-health-linked-to-worse-outcomes-in-hypertrophic-cardiomyopathy