CARDIOVASCULAR RISK FACTORS IN SOCIAL HOUSING RESIDENTS: A MULTI-SITE DESCRIPTIVE SURVEY IN OLDER ADULTS FROM ONTARIO, CANADA

Chronic disease prevalence and preventive care among Ontario social housing residents compared with the general population: a population-based cohort study

BACKGROUND

Older adults living in social housing report poor health and access to healthcare services. This study aimed to estimate the prevalence of chronic diseases, influenza vaccination and cancer screenings among social housing residents versus non-residents in Ontario, Canada.

METHODS

We conducted a population-based cohort study for all health-insured Ontarians alive and aged 40 or older as of 1 January 2020. Social housing residents were identified using postal codes. Validated health administrative data case definitions were used to identify individuals with diabetes, hypertension, chronic obstructive pulmonary disease, asthma, congestive heart failure and cardiovascular disease. Influenza vaccination and mammography, Pap and colorectal cancer screenings were identified among screen-eligible residents using health administrative data.

RESULTS

The prevalence of all chronic diseases was higher among social housing residents across all age groups: 40-59, 60-79 and 80+ years. Influenza vaccination rates in 2018-2019 were lower among social housing residents aged 60-79 and 80+ years. Mammography rates for women aged 50-69 years in 2018-2019 were 10-11% lower among social housing residents across all age groups compared with non-residents. Pap screening rates for women aged 40-69 in 2018-2019 were 6-8% lower among social housing residents. The percentage of colorectal screening in both women and men aged 52-74 was lower (9-10% in men and 6-7% in women) in social housing compared with the general population in 2019-2020.

CONCLUSION

There is a higher prevalence of chronic diseases and lower cancer screening rates among the growing population of older adults in social housing in Ontario, Canada.

Older adults in social housing: A systemically vulnerable population that needs to be prioritized

Older adults living in social housing are a vulnerable population with unique health challenges that often lead to poor health outcomes and high emergency service utilization. However, the needs of this population are frequently overlooked. This policy note describes the characteristics of older adults living in social housing in Canada and discusses why they are a vulnerable, underserved population in need of immediate attention and priority. Older adults in social housing have higher rates of chronic disease, lower quality of life, and lower health literacy and face challenges caused by various compounding social determinants of health. There is a large gap in research and tailored interventions focusing on this population. Based on these findings, the authors highlight the need for the allocation of resources to support this growing population, including dedicated funding, research, and programming. Proactively addressing the issues that exist in the health and social care of this high-needs population will also have larger implications for reducing healthcare system burden.

Health knowledge and self-efficacy to make health behaviour changes: a survey of older adults living in Ontario social housing

BACKGROUND

Older adults living in social housing are a vulnerable population facing unique challenges with health literacy and chronic disease self-management. We investigated this population's knowledge of cardiovascular disease and diabetes mellitus, and self-efficacy to make health behaviour changes (for example, physical activity). This study characterized the relationship between knowledge of health risk factors and self-efficacy to improve health behaviours, in order to determine the potential for future interventions to improve these traits.

METHODS

A cross-sectional study (health behaviour survey) with adults ages 55+ (n = 599) from 16 social housing buildings across five Ontario communities. Descriptive analyses conducted for demographics, cardiovascular disease and diabetes knowledge, and self-efficacy. Subgroup analyses for high-risk groups were performed. Multivariate logistic regressions models were used to evaluate associations of self-efficacy outcomes with multiple factors.

RESULTS

Majority were female (75.6%), white (89.4%), and completed high school or less (68.7%). Some chronic disease subgroups had higher knowledge for those conditions. Significant (p < 0.05) associations were observed between self-efficacy to increase physical activity and knowledge, intent to change, and being currently active; self-efficacy to increase fruit/vegetable intake and younger age, knowledge, and intent to change; self-efficacy to reduce alcohol and older age; self-efficacy to reduce smoking and intent to change, ability to handle crises, lower average number of cigarettes smoked daily, and less frequent problems with usual activities; self-efficacy to reduce stress and ability to handle crises.

CONCLUSIONS

Those with chronic diseases had greater knowledge about chronic disease. Those with greater ability to handle personal crises and intention to make change had greater self-efficacy to change health behaviours. Development of stress management skills may improve self-efficacy, and proactive health education may foster knowledge before chronic disease develops.