Social
Housing matters: The impact of housing instability on all-cause mortality among people with HIV in British Columbia, Canada Megan Marziali* Megan Marziali Katherine Kooij Michael Budu Monica Ye Cassidy Tam Valerie Nicholson Taylor McLinden Scott Emerson Julio Montaner Robert Hogg
Aim: British Columbia (BC), Canada, is experiencing a housing crisis marked by a shortage of safe and affordable housing. We explore the impact of housing instability on all-cause mortality among a cohort of people with HIV (PWH) in BC.
Methods: Data are from the Longitudinal Investigation into Supportive and Ancillary Health Services (LISA) study, a cross-sectional survey (2007-2010) (n=998). Survey data are linked with prospective administrative health data from the BC Centre for Excellence in HIV/AIDS Drug Treatment Program (DTP) until March 31, 2020. Selection bias into LISA was potentially introduced through oversampling PWH marginalized by sociostructural inequities. We used inverse probability of participation weighting (IPPW) to address this bias. We constructed participation weights using information from the entire DTP database, which includes all known PWH in BC accessing antiretrovirals via the DTP (including respondents and non-respondents to the LISA survey). We modeled the association between housing instability and all-cause mortality using IPPW-weighted log-binomial regression, adjusting for confounders. Leveraging time-to-event data, we also estimated hazards of mortality associated with housing instability using an adjusted, IPPW-weighted Cox proportional hazards model.
Results: In this sample, 215 (22%) people reported housing instability. Overall, 239 people (24%) died from any cause between completion of the LISA survey until March 31, 2020; of those people, 94 (39%) experienced housing instability. We found experiences of housing instability were associated with an increased risk of mortality (aRR: 1.33; 95%CI: 1.18-1.50); similarly, housing instability was associated with an increased hazard of mortality (aHR: 1.46; 95%CI: 1.08-1.96).
Conclusion: PWH experiencing housing instability may have a greater risk of mortality. Our findings add to the literature supporting a need to expand access to safe and affordable housing.