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