Housing instability and adverse perinatal outcomes: a systematic review

DiTosto, Julia D.; Holder, Kai; Beestrum, Molly; Yee, Lynn M.

doi:10.1016/j.ajogmf.2021.100477

Cited by 36 publications

(22 citation statements)

References 26 publications

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“…A related body of research has found associations between housing instability (primarily homelessness) during pregnancy and adverse maternal and infant health outcomes. 37 , 38 Our study contributes to this literature by investigating associations between housing affordability (which can have implications for housing stability) and SMM and adds to mounting evidence that housing characteristics beyond the physical features of buildings can have substantial consequences for health.…”

Section: Discussionmentioning

confidence: 84%

Association Between Housing Affordability and Severe Maternal Morbidity

2022

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ImportanceThe number of people living in unaffordable housing (relative to income) is projected to continue increasing as housing cost inflation outpaces incomes in the US. Although reproductive-aged women have disproportionately high housing costs, particularly around the time of childbirth, data on associations between housing costs and maternal health and the role of publicly supported affordable housing programs in mitigating those associations are lacking.ObjectiveTo estimate associations between area-level rental housing costs and severe maternal morbidity (SMM) and assess the potential mitigating role of publicly supported affordable housing.Design, Setting, and ParticipantsThis cross-sectional study linked New Jersey birth files from January 1, 2008, to December 31, 2018, to maternal hospital discharge records and municipal-level housing and demographic data from the state of New Jersey and the US Census Bureau. Data were analyzed from January to September 2022. The birth files contained records for all births in New Jersey, and the hospital discharge records contained information from all inpatient hospitalizations over the study period. A total of 1 004 000 birth records were matched to maternal discharge records and municipal-level data.ExposuresMunicipal-level rental costs relative to income (housing cost burden), availability of publicly supported affordable housing, and housing subsidy per person with an income lower than the federal poverty level.Main Outcomes and MeasuresSevere maternal morbidity was identified using diagnosis and procedure codes developed by the US Centers for Disease Control and Prevention to measure SMM.ResultsOf 1 004 000 mothers (mean [SD] age at birth, 29.8 [5.9] years; 44.7% White), 20 022 (2.0%) experienced SMM. Higher municipal rental housing costs were associated with greater odds of SMM (odds ratio [OR], 1.27; 95% CI, 1.01-1.60), particularly among mothers with less than a high school education (OR, 1.81; 95% CI, 1.06-3.10), and the positive associations decreased at higher levels of affordable housing availability. Among mothers with less than a high school education, the risk of SMM was 8.0% lower (risk ratio, 0.92; 95% CI, 0.85-1.00) for each additional $1000 annual municipal-level housing subsidy per person with an income lower than poverty level after controlling for rental costs and other characteristics, which translated to a 20.7% lower educational disparity in SMM.Conclusions and RelevanceIn this cross-sectional study, living in a municipality with higher rental housing costs was associated with higher odds of SMM, except when there was high availability of publicly supported affordable housing. These results suggest that greater availability of publicly supported affordable housing has the potential to mitigate the association between rental housing costs and SMM and reduce socioeconomic disparities in SMM.

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Section: Discussionmentioning

confidence: 84%

Association Between Housing Affordability and Severe Maternal Morbidity

2022

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“…The economic, environmental, political, and social conditions in which individuals are born, live, and interact with are recognized as social determinants of health. Minoritized groups more commonly experience multilevel structural disadvantages that contribute to health disparities, such as exposure to racism, food and housing insecurity, language barriers, low health literacy, and limited access to quality health care 15–18. Therefore, in discussing these disparities, we recognize racial and ethnic disparities as differences in health outcomes by the categorization of individuals based on socially constructed definitions that have no genetic basis 19.…”

Section: Adverse Pregnancy Outcomes and Long-term Healthmentioning

confidence: 99%

“…Minoritized groups more commonly experience multilevel structural disadvantages that contribute to health disparities, such as exposure to racism, food and housing insecurity, language barriers, low health literacy, and limited access to quality health care. [15][16][17][18] Therefore, in discussing these disparities, we recognize racial and ethnic disparities as differences in health outcomes by the categorization of individuals based on socially constructed definitions that have no genetic basis. 19 Addressing such disparities requires a focus on the promotion of health equity, defined as the absence of health disparities when every person has the opportunity to "attain his or her full health potential."…”

Section: Adverse Pregnancy Outcomes and Long-term Healthmentioning

confidence: 99%

Improving Postpartum and Long-Term Health After an Adverse Pregnancy Outcome: Examining Interventions From a Health Equity Perspective

DiTosto

Roytman

Dolan

et al. 2022

Clinical Obstetrics &Amp; Gynecology

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Gestational diabetes mellitus and hypertensive disorders in pregnancy are adverse pregnancy outcomes (APOs) that affect 15% of pregnancies in the United States. These APOs have long-term health implications, with greater risks of future cardiovascular and chronic disease later in life. In this manuscript, we review the importance of timely postpartum follow-up and transition to primary care after APOs for future disease prevention. We also discuss interventions to improve postpartum follow-up and long-term health after an APO. In recognizing racial and ethnic disparities in APOs and chronic disease, we review important considerations of these interventions through a health equity lens.

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“…(Bell et al, 2018;Gaskin et al, 2014;LaVeist, Pollack, Thorpe, Fesahazion, & Gaskin, 2011) Themes of toxicology ring true for the clinical impact of SDOH, namely, that there is individual variation in susceptibility that is influenced by the dose, timing, and duration of SDOH exposures. Both individual and neighborhood level SDOH risks are associated with hypertensive disorders during pregnancy (Stanhope, Adeyemi, Li, Johnson, & Boulet, 2021) and perinatal outcomes (Bangma, Hartwell, Santos, O'Shea, & Fry, 2021;Burris et al, 2020;DiTosto, Holder, Soyemi, Beestrum, & Yee, 2021), and hospital discharge practices (Hudson, 2021). With regards to neonatal outcomes and childhood development, the timing of SDOH factors, such as medical insurance coverage of prenatal care, has critical consequences on preterm birth rates and, in general, perinatal outcomes are worse for Medicaid-insured patients.…”

Section: Incorporation Of Sdoh Factors In Translational and Biomedica...mentioning

confidence: 99%

Inclusion of Social and Structural Determinants of Health to Advance Understanding of their Influence on the Biology of Chronic Disease

et al. 2022

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Social Determinants of Health (SDOH) consider social, political, and economic factors that contribute to health disparities in patients and populations. The most common health-related SDOH exposures are food and housing insecurity, financial instability, transportation needs, low levels of education, and psychosocial stress. These domains describe risks that can impact health outcomes more than health care. Epidemiologic and translational research demonstrates that SDOH factors represent exposures that predict harm and impact the health of individuals. International and national guidelines urge health professionals to address SDOH in clinical practice and public health. The further implementation of these recommendations into basic and translational research, however, is lagging. Herein, we consider a precision health framework to describe how SDOH contributes to the exposome and exacerbates physiologic pathways that lead to chronic disease. SDOH factors are associated with various forms of stressors that impact physiological processes through epigenetic, inflammatory, and redox regulation. Many SDOH exposures may add to or potentiate the pathologic effects of additional environmental exposures. This overview aims to inform basic life science and translational researchers about SDOH exposures that can confound associations between classic biomedical determinants of disease and health outcomes. To advance the study of toxicology through either qualitative or quantitative assessment of exposures to chemical and biological substances, a more complete environmental evaluation should include SDOH exposures. We discuss common approaches to measure SDOH factors at individual and population levels and review the associations between SDOH risk factors and physiologic mechanisms that influence chronic disease. We provide clinical and policy-based motivation to encourage researchers to consider the impact of SDOH exposures on study results and data interpretation. With valid measures of SDOH factors incorporated into study design and analyses, future toxicological research may contribute to an evidence base that can better inform prevention and treatment options, to improve equitable clinical care and population health.

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Housing instability and adverse perinatal outcomes: a systematic review

Cited by 36 publications

References 26 publications

Association Between Housing Affordability and Severe Maternal Morbidity

Association Between Housing Affordability and Severe Maternal Morbidity

Improving Postpartum and Long-Term Health After an Adverse Pregnancy Outcome: Examining Interventions From a Health Equity Perspective

Inclusion of Social and Structural Determinants of Health to Advance Understanding of their Influence on the Biology of Chronic Disease

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