{"doi":"10.1016/j.xkme.2019.12.009","title":"Housing Instability and Health Care Engagement Among People With CKD","abstract":"Housing instability affects more than 38.1 million American households and is characterized by high housing costs or overcrowded living conditions.1Kushel M.B. Gupta R. Gee L. Haas J.S. Housing instability and food insecurity as barriers to health care among low-income Americans.J Gen Intern Med. 2006; 21: 71-77Crossref PubMed Scopus (476) Google Scholar,2Harvard University Joint Center for Housing StudiesThe state of the nation's housing.https://www.jchs.harvard.edu/sites/default/files/Harvard_JCHS_State_of_the_Nations_Housing_2019.pdfDate accessed: September 4, 2019Google Scholar Engagement with nephrology care is of interest in this population because housing instability has been associated with risk factors for chronic kidney disease (CKD),3Vijayaraghavan M. Kushel M.B. Vittinghoff E. et al.Housing instability and incident hypertension in the CARDIA cohort.J Urban Health. 2013; 90: 427-441Crossref PubMed Scopus (16) Google Scholar and homeless persons with CKD are more likely to progress to end-stage kidney disease than people with stable housing.4Hall Y.N. Choi A.I. Himmelfarb J. Chertow G.M. Bindman A.B. Homelessness and CKD: a cohort study.Clin J Am Soc Nephrol. 2012; 7: 1094-1102Crossref PubMed Scopus (19) Google Scholar In the general population, housing instability is associated with not having a usual source of care and postponing medical care.1Kushel M.B. Gupta R. Gee L. Haas J.S. Housing instability and food insecurity as barriers to health care among low-income Americans.J Gen Intern Med. 2006; 21: 71-77Crossref PubMed Scopus (476) Google Scholar,5Reid K.W. Vittinghoff E. Kushel M.B. Association between the level of housing instability, economic standing and health care access: a meta-regression.J Health Care Poor Underserved. 2008; 19: 1212-1228Crossref PubMed Scopus (116) Google Scholar The relation of housing instability to health care use among people with CKD is unknown. We sought to examine whether housing instability was associated with postponing medical care among persons with CKD and hypothesized that those experiencing housing instability would be more likely to report postponing medical care that they believed to be necessary. We used data from the Healthy Aging in Neighborhoods of Diversity Across the Life Span (HANDLS) study (Baltimore, MD).6Evans M.K. Lepkowski J.M. Powe N.R. LaVeist T. Kuczmarski M.F. Zonderman A.B. Healthy aging in neighborhoods of diversity across the life span (HANDLS): overcoming barriers to implementing a longitudinal, epidemiologic, urban study of health, race, and socioeconomic status.Ethn Dis. 2010; 20: 267-275PubMed Google Scholar HANDLS is a population-based cohort study examining the influence and interaction of race and socioeconomic status on the development of health disparities among minorities and lower-socioeconomic-status groups.6Evans M.K. Lepkowski J.M. Powe N.R. LaVeist T. Kuczmarski M.F. Zonderman A.B. Healthy aging in neighborhoods of diversity across the life span (HANDLS): overcoming barriers to implementing a longitudinal, epidemiologic, urban study of health, race, and socioeconomic status.Ethn Dis. 2010; 20: 267-275PubMed Google Scholar The cohort included 3,720 black and white community-dwelling individuals between the ages of 30 and 64 years who were sampled from 13 socioeconomically diverse neighborhoods. Participants were enrolled between August 2004 and November 2008. Each participant provided written informed consent, and the National Institute of Environmental Health Sciences, National Institutes of Health approved the study protocol (09-AG-N248). We performed a cross-sectional analysis evaluating the association between housing instability and postponement of medical care at HANDLS visit 4 (September 2013 to September 2017). Individuals were included if they attended visit 4 and had prevalent CKD (estimated glomerular filtration rate < 60 mL/min/1.73 m2 and/or urinary albumin-creatinine ratio ≥ 30 mg/g; N = 558).7Kidney Disease: Improving Global","journal":"Kidney Medicine","year":2020,"id":81826,"datarank":0.561932178752925,"base_score":2.639057329615259,"endowment":2.639057329615259,"self_citation_contribution":0.3958585994422889,"citation_network_contribution":0.16607357931063607,"self_endowment_contribution":0.3958585994422889,"citer_contribution":0.16607357931063607,"corpus_percentile":null,"corpus_rank":null,"citation_count":13,"citer_count":7,"citers_with_citation_signal":5,"citers_with_endowment":5,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9627,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2020-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":370327,"name":"Dingfen Han","orcid":null,"position":1,"is_corresponding":false},{"id":265840,"name":"Delphine S. Tuot","orcid":"0000-0003-1484-8945","position":2,"is_corresponding":false},{"id":422604,"name":"Elizabeth A. Jacobs","orcid":"0000-0002-5549-7718","position":3,"is_corresponding":false},{"id":22038,"name":"Alan B. Zonderman","orcid":"0000-0002-6523-4778","position":4,"is_corresponding":false},{"id":108724,"name":"Michele K. Evans","orcid":"0000-0002-8546-2831","position":5,"is_corresponding":false},{"id":265847,"name":"Deidra C. Crews","orcid":"0000-0003-3425-5776","position":6,"is_corresponding":false},{"id":369103,"name":"Tessa K. Novick","orcid":"0000-0002-5659-8772","position":0,"is_corresponding":true}],"reference_count":8,"raw_metadata":{"citation_network_status":"fetched"},"created_at":"2026-07-18T21:52:58.921847Z","pmid":"32734256","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}