Housing insecurity is a powerful social determinant of health that is associated with increased all-cause mortality. The health consequences of and contributors to housing insecurity are poorly studied, which makes preventative care elusive for this population. In order to address these issues, we assessed the prevalence of housing insecurity among sudden death victims and examined its relationship to sudden death, mental illness, and clinical comorbidities.
From 1 March 2013 to 28 February 2015, out-of-hospital deaths in Wake County, North Carolina, were screened and adjudicated to identify 399 sudden deaths among residents between the ages of 18 and 64. A control sample of 1,101 living patients were generated by randomly sampling for age, gender, and Wake County residence from the Carolina Data Warehouse for Health. Housing status was abstracted from clinical records from sudden death victims and controls.
Housing insecurity was documented in 28 (7.1%) of victims and 47 (4.3%) of controls (OR(95CI): 1.71(1.05-3.2)). This difference remained significant after adjusting for hypertension, age, and diabetes. However, when additionally adjusting for depression, anxiety, alcohol abuse, substance abuse, schizophrenia, and bipolar disorder, the increased prevalence of housing insecurity in the sudden death group became insignificant.
Housing insecure individuals experience a higher burden of sudden death than housing secure individuals. Mental illness appears to confound the relationship between housing insecurity and sudden death. Treating underlying mental illness may be a path towards specializing clinical care to optimize health outcomes for housing insecure individuals.
Optimize health outcomes for housing insecure individuals by acknowledging that housing insecurity appears to be a risk factor for sudden death - a relationship complicated by mental illness. Patients with housing insecurity should be screened for mental illness, and treatment and referral to a mental illness specialist should be considered.