Essays on the impact of housing insecurity and other socioeconomic factors on health-related outcomes among Medicare beneficiaries during the Great Recession

December 2023
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While previous recessions have informed much of our modern-day fiscal policy, they have informed less of relevant housing or healthcare policies focused on preventing or mitigating the effects of housing insecurity during economic crises. In this dissertation, I drew from nationally representative Health and Retirement Study (HRS) data to evaluate the role of housing insecurity on healthcare and health outcomes among Medicare beneficiaries ages 65+ during the Great Recession (2008-2012). In Paper 1, I assessed associations between housing insecurity and foregone medication due to cost. Findings indicated a greater odds of foregone medication among individuals experiencing onset versus persistent housing insecurity, suggesting that unexpected acute economic shocks leave households with little time to adapt and lead to forced trade-offs in basic needs. Guided by the disparities literature, in Paper 2, I examined racial differences in foregone medication among non-Hispanic White (NHW) and Black (NHB) beneficiaries during the 2008 Recession peak to evaluate the extent to which housing insecurity and predisposing, need-based and enabling factors within Andersen’s healthcare utilization model explained the Black-White racial difference. Findings indicated statistically significant associations between race and foregone medication that were explained with the addition of non-housing wealth. These findings suggest wealth was a stronger driver of racial disparities in foregone medication than housing insecurity during the Recession. Guided by stress-health frameworks, in Paper 3, I examined the association of housing insecurity with depressive symptoms among Medicare beneficiaries during the Recession and further assessed the extent to which Andersen’s factors explained this relationship. Findings indicated that baseline housing insecurity had a positive yet insignificant effect on average depressive symptoms during 2008-2012, however, this relationship became negative and significant with the addition of baseline wealth and tenure status, suggesting the strong confounding effect of these variables on the role of housing insecurity on depression. In summary, the three papers fill important gaps in our understanding of the health effects of the Great Recession, including the extent to which housing insecurity was associated with foregone medication due to cost and depression as well as how patterns in forgone medication differed by race and other socioeconomic characteristics.