Journal of Urban Health

, Volume 88, Issue 3, pp 469–478 | Cite as

A Case–Control Study of Home Foreclosure, Health Conditions, and Health Care Utilization

  • Craig PollackEmail author
  • Shanu K. Kurd
  • Alice Livshits
  • Mark Weiner
  • Julia Lynch


Though rates of foreclosure are at a historic high, relatively little is known about the link between foreclosure and health. We performed a case–control study to examine health conditions and health care utilization in the time period prior to foreclosure. Homeowners who received a home foreclosure notice from 2005 to 2008 were matched (by name and address) to a university hospital system in Philadelphia and compared with controls who received care from the hospital system and who lived in the same zip code as cases. Outcome measures included prevalent health conditions and visit history in the 2 years prior to foreclosure. We found that people undergoing foreclosure were similar to controls with regard to age, gender, and insurance status but significantly more likely to be African American. Rates of hypertension and renal disease were significantly higher among cases after adjustment for sociodemographic characteristics. In the 2 years prior to foreclosure, cases were more likely to visit the emergency department, have an outpatient visit, and have a no-show appointment. Cases were less likely to have a primary care physicians (PCP) visit in the 6 months immediately prior to the receipt of a foreclosure notice. The results suggest changes in health care utilization in the time period prior to foreclosure. Policies designed to decrease the incidence of home foreclosure and support people during the process should consider its association with poor health and changes in health care utilization.


Housing Socioeconomic factors Foreclosure 



The authors would like Katrina Armstrong for her advice. This work was presented at the American Public Health Association annual meeting, Philadelphia, PA, United States on November 11, 2009 and the Society of General Internal Medicine annual meeting, Minneapolis, MN, United States on May 1, 2010.


Funding was provided by the Leonard Davis Institute of Health Economics, the Robert Wood Johnson Foundation Clinical Scholars Program and the Philadelphia VA Medical Center, at the University of Pennsylvania.


  1. 1.
    RealtyTrac. Record 2.9 million U.S. properties receive foreclosure filings in 2010 despite 30-month low in December. Accessed 5 Apr 2011.
  2. 2.
    Mortgage Bankers Association. Delinquencies, foreclosure starts increase in latest MBA National Delinquency Survey, 2010. Accessed 27 May 2010.
  3. 3.
    Joint Center for Housing Studies, The State of the Nation’s Housing 2009. Cambridge, MA: Harvard University; 2009: 3.Google Scholar
  4. 4.
    Majority Staff of the Joint Economic Committee. The subprime lending crisis 2007. Washington, DC: US Senate. Accessed 16 June 2009.
  5. 5.
    Bureau of Labor Statistics. Employment situation summary, 2010. Accessed 14 Jan 2009.
  6. 6.
    Joint Center for Housing Studies. The State of the Nation’s Housing 2010. Cambridge, MA: Harvard University; 2010: 1–3, 18–19.Google Scholar
  7. 7.
    NeighborWorks America, National Foreclosure Mitigation Counseling Program Congressional Update Activity through January 31, 2010. Accessed 10 June 2010.
  8. 8.
    Pollack CE, Lynch J. Health status of people undergoing foreclosure in the Philadelphia Region. Am J Public Health. 2009; 99: 1833–9.PubMedCrossRefGoogle Scholar
  9. 9.
    Robertson CT, Egelhof R, Hoke M. Get sick, get out: the medical caues of home mortgage foreclosures. Health Matrix. 2008; 18: 65–105.PubMedGoogle Scholar
  10. 10.
    Steptoe A, Brydon L, Kunz-Ebrecht S. Changes in financial strain over 3 years, ambulatory blood pressure, and cortisol responses to awakening. Psychosom Med. 2005; 67(2): 281–7.PubMedCrossRefGoogle Scholar
  11. 11.
    Szanton SL, Allen JK, Thorpe RJ Jr, Seeman T, Bandeen-Roche K, Fried LP. Effect of financial strain on mortality in community-dwelling older women. J Gerontol B Psychol Sci Soc Sci. 2008; 63(6): S369–74.PubMedGoogle Scholar
  12. 12.
    Kahn JR, Pearlin LI. Financial strain over the life course and health among older adults. J Health Soc Behav. 2006; 47(1): 17–31.PubMedCrossRefGoogle Scholar
  13. 13.
    Ferraro K, Su Y. Financial strain, social relations, and psychological distress among older people: a cross-cultural analysis. J Gerontol B Psychol Sci Soc Sci. 1999; 54(1): S3–15.PubMedGoogle Scholar
  14. 14.
    Matthews RJ, Smith LK, Hancock RM, Jagger C, Spiers NA. Socioeconomic factors associated with the onset of disability in older age: a longitudinal study of people aged 75 years and over. Soc Sci Med. 2005; 61(7): 1567–75.PubMedCrossRefGoogle Scholar
  15. 15.
    Blazer DG, Sachs-Ericsson N, Hybels CF. Perception of unmet basic needs as a predictor of mortality among community-dwelling older adults. Am J Public Health. 2005; 95(2): 299–304.PubMedCrossRefGoogle Scholar
  16. 16.
    Lantz PM, House JS, Mero RP, Williams DR. Stress, life events, and socioeconomic disparities in health: results from the Americans’ changing lives study. J Health Soc Behav. 2005; 46(3): 274–88.PubMedCrossRefGoogle Scholar
  17. 17.
    Pollack CE, Lynch J, Alley DE, Cannuscio C. Foreclosure and health status. LDI Issue Brief. 2010; 15(2): 1–4.PubMedGoogle Scholar
  18. 18.
    HCUP CCS. Healthcare Cost and Utilization Project (HCUP). January 2011. Agency for Healthcare Research and Quality, Rockville, MD, Accessed 18 March 2011.
  19. 19.
    National Association of Community Health Centers. Recession brings more patients to community health centers 2009. Accessed 21 April 2010.
  20. 20.
    Villegas, A. Community health centers strained by recession, face bigger caseloads under reform. Kaiser Health News 2009. Accessed 21 April 2010.
  21. 21.
    Nutting PA, Goodwin MA, Flocke SA, Zyzanski SJ, Stange KC. Continuity of primary care: to whom does it matter and when? Ann Fam Med. 2003; 1(3): 149–55.PubMedCrossRefGoogle Scholar
  22. 22.
    Bennett GG, Scharoun-Lee M, Tucker-Seeley R. Will the public’s health fall victim to the home foreclosure epidemic? PLoS Med. 2009; 6(6): e1000087.PubMedCrossRefGoogle Scholar
  23. 23.
    Drentea P, Lavrakas PJ. Over the limit: the association among health, race and debt. Soc Sci Med. 2000; 50(4): 517–29.PubMedCrossRefGoogle Scholar
  24. 24.
    Wilson SH, Walker GM. Unemployment and health: a review. Public Health. 1993; 107(3): 153–62.PubMedCrossRefGoogle Scholar
  25. 25.
    Simon GE, VonKorff M. Recognition, management, and outcomes of depression in primary care. Arch Fam Med. 1995; 4(2): 99–105.PubMedCrossRefGoogle Scholar
  26. 26.
    Wells KB, Schoenbaum M, Unützer J, Lagomasino IT, Rubenstein LV. Quality of care for primary care patients with depression in managed care. Arch Fam Med. 1999; 8(6): 529–36.PubMedCrossRefGoogle Scholar
  27. 27.
    Kaplan DH, Sommers GG. An analysis of the relationship between housing foreclosures, lending practices, and neighborhood ecology: evidence from a distressed county. Prof Geogr. 2009; 61(1): 101–20.CrossRefGoogle Scholar
  28. 28.
    Krieger N, Williams DR, Moss NE. Measuring social class in US public health research: concepts, methodologies, and guidelines. Annu Rev Public Health. 1997; 18: 341–78.PubMedCrossRefGoogle Scholar
  29. 29.
    US Census Bureau. Homeownership rates for the 75 largest MSAS: 2005 to 2008. Accessed 19 May 2010.

Copyright information

© The New York Academy of Medicine 2011

Authors and Affiliations

  • Craig Pollack
    • 1
    • 4
    Email author
  • Shanu K. Kurd
    • 2
  • Alice Livshits
    • 2
  • Mark Weiner
    • 2
  • Julia Lynch
    • 3
    • 4
  1. 1.Johns Hopkins University School of Medicine and Bloomberg School of Public HealthBaltimoreUSA
  2. 2.University of Pennsylvania School of MedicinePhiladelphiaUSA
  3. 3.Department of Political ScienceUniversity of PennsylvaniaPhiladelphiaUSA
  4. 4.Leonard Davis Institute of Health EconomicsUniversity of PennsylvaniaPhiladelphiaUSA

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