title: Beyond the Great Recession: Was the Foreclosure Crisis Harmful to the Health of Individuals With Diabetes?
abstract: The housing foreclosure crisis was harmful to the financial well-being of many households. In the present study, we investigated the health effects of the housing foreclosure crisis on glycemic control within a population of patients with diabetes. We hypothesized that an increase in the neighborhood foreclosure rate could worsen glycemic control by activating stressors such as higher neighborhood crime, lower housing prices, and erosion of neighborhood social cohesion. To test this, we linked public foreclosure records at the census-block level with clinical records from 2006 to 2009 of patients with diabetes. We specified individual fixed-effects models and controlled for individual time-invariant confounders and area-level time-varying confounders, including housing prices and unemployment rate, to estimate the effect of the foreclosure rate per census-block group on glycated hemoglobin. We found no statistically significant relationship between changes in the neighborhood foreclosure rate per block group in the prior year and changes in glycated hemoglobin. There is no evidence that increased foreclosure rates worsened glycemic control in this continuously insured population with diabetes. More research is needed to inform our knowledge of the role of insurance and health-care delivery systems in protecting the health of diabetic patients during times of economic stress.
authors.forename: Janelle
authors.initials: J
authors.lastname: Downing
authors.forename: Barbara
authors.initials: B
authors.lastname: Laraia
authors.forename: Hector
authors.initials: H
authors.lastname: Rodriguez
authors.forename: William H
authors.initials: WH
authors.lastname: Dow
authors.forename: Nancy
authors.initials: N
authors.lastname: Adler
authors.forename: Dean
authors.initials: D
authors.lastname: Schillinger
authors.forename: E Margaret
authors.initials: EM
authors.lastname: Warton
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Karter
mesh_terms: D000368:Aged; D003920:Diabetes Mellitus / Q000097:blood / Q000191:economics*; D057172:Economic Recession; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis*; D006304:Health Status; D006798:Housing / Q000191:economics*; D006801:Humans; D007348:Insurance, Health; D008297:Male; D008484:Medicaid; D017057:Medically Uninsured; D008875:Middle Aged; D015233:Models, Statistical; D012959:Socioeconomic Factors; D014481:United States
chemical_list: D006442:Glycated Hemoglobin
keywords: HbA1c; diabetes; foreclosure; glycemic; managed care; neighborhood; recession; unemployment