Housing and Inequalities in US Life Expectancy, Child and Youth Mortality, and All-Cause and Cause-Specific Mortality, 1979-2020: Results from the National Longitudinal Mortality Study and the National Vital Statistics System

Abstract

Background: Limited research exists on the association between housing, life expectancy, and mortality disparities in the United States (US). Using longitudinal individual-level and pooled county-level mortality data from 1979 to 2020, we examine disparities in life expectancy, child and youth mortality, and all-cause and cause-specific mortality in the US by several housing variables. Methods: Using the 1979-2011 National Longitudinal Mortality Study (N=1,313,627) and the 2011-2020 linked county-level National Mortality Database and American Community Survey, we analyzed disparities in life expectancy and all-cause and cause-specific disparities by housing tenure, household crowding, and housing stability. Multivariate Cox proportional hazards regression was used to analyze individual-level mortality differentials by housing tenure. Age-adjusted mortality rates and rate ratios were used to analyze area-level disparities in mortality by housing variables. Results: US homeowners had, on average, a 3.5-year longer life expectancy at birth than renters (74.22 vs. 70.76 years), with advantages in longevity associated with homeownership being greater for males than for females; for American Indians/Alaska Natives, non-Hispanic Whites, and non-Hispanic Blacks than for Asian/Pacific islanders and Hispanics; and for the US-born than for immigrants. Compared with renters, homeowners had 22% lower risks of all-cause mortality, 15% lower child mortality, 17% lower youth mortality, and significantly lower mortality from cardiovascular diseases, all cancers combined, stomach, liver, esophageal and cervical cancer, diabetes, influenza and pneumonia, COPD, cirrhosis, kidney disease, HIV/AIDS, infectious diseases, unintentional injuries, suicide, and homicide. Conclusion and Global Health Implications: Several aspects of housing are strongly associated with life expectancy, child and youth mortality, and all-cause and cause-specific mortality in the US. Policies that aim to provide well-designed, accessible, and affordable housing to residents of both developed and developing countries are important policy options for addressing one of the most fundamental determinants of health for disadvantaged individuals and communities and for reducing health inequities globally.