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The effect of unstable housing on HIV treatment biomarkers: An instrumental variables approach

Author

Listed:
  • Galárraga, Omar
  • Rana, Aadia
  • Rahman, Momotazur
  • Cohen, Mardge
  • Adimora, Adaora A.
  • Sosanya, Oluwakemi
  • Holman, Susan
  • Kassaye, Seble
  • Milam, Joel
  • Cohen, Jennifer
  • Golub, Elizabeth T.
  • Metsch, Lisa R.
  • Kempf, Mirjam-Colette

Abstract

Unstable housing, including homelessness, is a public policy concern for all populations, and more critically for people with a serious health condition such as HIV. We measure the effect of unstable housing on HIV treatment biomarkers: viral suppression (viral load < 200 HIV RNA copies per ml) and adequate CD4+ T-cell count (CD4>350 cells per μl). We use panel data (1995–2015) from 3082 participants of the Women's Interagency HIV Study (WIHS) sites in Bronx and Brooklyn (NY), Chicago (IL), Los Angeles and San Francisco (CA), and Washington (DC). The instrumental variable (IV) measures allocations for the Housing Opportunities for People with AIDS (HOPWA) per person newly infected with HIV, and it represents actual availability of housing assistance for HIV-positive persons at the metropolitan area level. Using an extended probit model with the IV, we find that unstable housing reduces the likelihood of viral suppression by 51 percentage points, and decreases the probability of having adequate CD4 cell count by 53 percentage points. The endogeneity-corrected results are larger than naïve probits, which show decreases of 8.1 and 7.8 percentage points, respectively. The hypothesized pathways for the effect are: decreased use of mental healthcare/counseling, any healthcare, and less continuity of care. Increasing efforts to improve housing assistance, including HOPWA, and other interventions to make housing more affordable for low-income populations, and HIV-positive populations in particular, may be warranted not only for the benefits of stable housing, but also to improve HIV-related biomarkers.

Suggested Citation

  • Galárraga, Omar & Rana, Aadia & Rahman, Momotazur & Cohen, Mardge & Adimora, Adaora A. & Sosanya, Oluwakemi & Holman, Susan & Kassaye, Seble & Milam, Joel & Cohen, Jennifer & Golub, Elizabeth T. & Met, 2018. "The effect of unstable housing on HIV treatment biomarkers: An instrumental variables approach," Social Science & Medicine, Elsevier, vol. 214(C), pages 70-82.
    • Handle: RePEc:eee:socmed:v:214:y:2018:i:c:p:70-82
    DOI: 10.1016/j.socscimed.2018.07.051
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    as
    1. Fussell, Elizabeth & Lowe, Sarah R., 2014. "The impact of housing displacement on the mental health of low-income parents after Hurricane Katrina," Social Science & Medicine, Elsevier, vol. 113(C), pages 137-144.
    2. Michaud, Pierre-Carl & Crimmins, Eileen M. & Hurd, Michael D., 2016. "The effect of job loss on health: Evidence from biomarkers," Labour Economics, Elsevier, vol. 41(C), pages 194-203.
    3. repec:pri:cheawb:case_paxson_economic_status_paper is not listed on IDEAS
    4. Acton, Jan Paul, 1975. "Nonmonetary Factors in the Demand for Medical Services: Some Empirical Evidence," Journal of Political Economy, University of Chicago Press, vol. 83(3), pages 595-614, June.
    5. Jeffrey R. Kling & Jens Ludwig & Lawrence F. Katz, 2005. "Neighborhood Effects on Crime for Female and Male Youth: Evidence from a Randomized Housing Voucher Experiment," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 120(1), pages 87-130.
    6. Angrist, Joshua D, 2001. "Estimations of Limited Dependent Variable Models with Dummy Endogenous Regressors: Simple Strategies for Empirical Practice," Journal of Business & Economic Statistics, American Statistical Association, vol. 19(1), pages 2-16, January.
    7. Downing, Janelle, 2016. "The health effects of the foreclosure crisis and unaffordable housing: A systematic review and explanation of evidence," Social Science & Medicine, Elsevier, vol. 162(C), pages 88-96.
    8. Chiburis, Richard C. & Das, Jishnu & Lokshin, Michael, 2012. "A practical comparison of the bivariate probit and linear IV estimators," Economics Letters, Elsevier, vol. 117(3), pages 762-766.
    9. Eckel, Catherine C. & El-Gamal, Mahmoud A. & Wilson, Rick K., 2009. "Risk loving after the storm: A Bayesian-Network study of Hurricane Katrina evacuees," Journal of Economic Behavior & Organization, Elsevier, vol. 69(2), pages 110-124, February.
    10. Marianne Bitler & Hilary Hoynes, 2015. "Living Arrangements, Doubling Up, and the Great Recession: Was This Time Different?," American Economic Review, American Economic Association, vol. 105(5), pages 166-170, May.
    11. Aidala, A.A. & Wilson, M.G. & Shubert, V. & Gogolishvili, D. & Globerman, J. & Rueda, S. & Bozack, A.K. & Caban, M. & Rourke, S.B., 2016. "Housing status, medical care, and health outcomes among people living with HIV/AIDS: A systematic review," American Journal of Public Health, American Public Health Association, vol. 106(1), pages 1-23.
    12. O'Flaherty, B., 1995. "An Economic Theory of Homelessness and Housing," Journal of Housing Economics, Elsevier, vol. 4(1), pages 13-49, March.
    13. Russell James, 2009. "Tenant time preference as a barrier to homeownership," Applied Economics Letters, Taylor & Francis Journals, vol. 16(10), pages 1073-1077.
    14. Brian A. Jacob & Jens Ludwig, 2012. "The Effects of Housing Assistance on Labor Supply: Evidence from a Voucher Lottery," American Economic Review, American Economic Association, vol. 102(1), pages 272-304, February.
    15. Jeffrey M Wooldridge, 2010. "Econometric Analysis of Cross Section and Panel Data," MIT Press Books, The MIT Press, edition 2, volume 1, number 0262232588, April.
    16. M. Christopher Auld, 2002. "Disentangling the effects of morbidity and life expectancy on labor market outcomes," Health Economics, John Wiley & Sons, Ltd., vol. 11(6), pages 471-483, September.
    17. Hendrik Jürges & Eberhard Kruk & Steffen Reinhold, 2013. "The effect of compulsory schooling on health—evidence from biomarkers," Journal of Population Economics, Springer;European Society for Population Economics, vol. 26(2), pages 645-672, April.
    18. Jane G. Fortson & Lisa Sanbonmatsu, 2010. "Child Health and Neighborhood Conditions: Results from a Randomized Housing Voucher Experiment," Journal of Human Resources, University of Wisconsin Press, vol. 45(4), pages 840-864.
    19. repec:pri:cheawb:case_paxson_economic_status_paper.pdf is not listed on IDEAS
    20. Pinka Chatterji & Heesoo Joo & Kajal Lahiri, 2012. "Beware Of Being Unaware: Racial/Ethnic Disparities In Chronic Illness In The Usa," Health Economics, John Wiley & Sons, Ltd., vol. 21(9), pages 1040-1060, September.
    21. Grossman, Michael, 1972. "On the Concept of Health Capital and the Demand for Health," Journal of Political Economy, University of Chicago Press, vol. 80(2), pages 223-255, March-Apr.
    22. Douglas Staiger & James H. Stock, 1997. "Instrumental Variables Regression with Weak Instruments," Econometrica, Econometric Society, vol. 65(3), pages 557-586, May.
    23. Omar Galárraga & David S. Salkever & Judith A. Cook & Stephen J. Gange, 2010. "An instrumental variables evaluation of the effect of antidepressant use on employment among HIV‐infected women using antiretroviral therapy in the United States: 1996–2004," Health Economics, John Wiley & Sons, Ltd., vol. 19(2), pages 173-188, February.
    24. Lawrence F. Katz & Jeffrey R. Kling & Jeffrey B. Liebman, 2001. "Moving to Opportunity in Boston: Early Results of a Randomized Mobility Experiment," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 116(2), pages 607-654.
    25. David Roodman, 2011. "Fitting fully observed recursive mixed-process models with cmp," Stata Journal, StataCorp LP, vol. 11(2), pages 159-206, June.
    26. Thomson, Hilary & Thomas, Sian, 2015. "Developing empirically supported theories of change for housing investment and health," Social Science & Medicine, Elsevier, vol. 124(C), pages 205-214.
    27. Anne Case & Darren Lubotsky & Christina Paxson, 2002. "Economic Status and Health in Childhood: The Origins of the Gradient," American Economic Review, American Economic Association, vol. 92(5), pages 1308-1334, December.
    28. repec:mpr:mprres:7081 is not listed on IDEAS
    29. Gennetian, Lisa A. & Sciandra, Matthew & Sanbonmatsu, Lisa & Ludwig, Jens & Katz, Lawrence F. & Duncan, Greg J. & Kling, Jeffrey R. & Kessler, Ronald, 2012. "The Long-Term Effects of Moving to Opportunity on Youth Outcomes," Scholarly Articles 33950779, Harvard University Department of Economics.
    30. Jan Paul Acton, 1976. "Demand for Health Care among the Urban Poor, with Special Emphasis on the Role of Time," NBER Chapters, in: The Role of Health Insurance in the Health Services Sector, pages 163-214, National Bureau of Economic Research, Inc.
    31. Brian A. Jacob & Max Kapustin & Jens Ludwig, 2015. "The Impact of Housing Assistance on Child Outcomes: Evidence from a Randomized Housing Lottery," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 130(1), pages 465-506.
    32. Adam, Emma & Kessler, Ronald & Gennetian, Lisa A. & Duncan, Greg J. & Congdon, William J. & Katz, Lawrence F. & Ludwig, Jens & Sanbonmatsu, Lisa & Yang, Fanghua & Kling, Jeffrey R. & Lindau, Stacy Tes, 2012. "The Long-Term Effects of Moving to Opportunity on Adult Health and Economic Self-Sufficiency," Scholarly Articles 33950780, Harvard University Department of Economics.
    33. Angrist, Joshua D, 2001. "Estimations of Limited Dependent Variable Models with Dummy Endogenous Regressors: Simple Strategies for Empirical Practice: Reply," Journal of Business & Economic Statistics, American Statistical Association, vol. 19(1), pages 27-28, January.
    34. Wooldridge, Jeffrey M., 2014. "Quasi-maximum likelihood estimation and testing for nonlinear models with endogenous explanatory variables," Journal of Econometrics, Elsevier, vol. 182(1), pages 226-234.
    35. Buchanan, D. & Kee, R. & Sadowski, L.S. & Garcia, D., 2009. "The health impact of supportive housing for HIV-positive homeless patients: a randomized controlled trial," American Journal of Public Health, American Public Health Association, vol. 99(S3), pages 675-680.
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