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COVID-19 Risk Factors Among HUD-Assisted Renters

Photo of an elderly woman holding hands with a doctor, both wearing masks.The COVID-19 pandemic, with its associated job loss and economic turmoil, highlighted the importance of housing stability. Photo credit: istockphoto.com/Ridofranz

Veronica Helms, a social science analyst and Craig Pollack, a guest researcher from Johns Hopkins Bloomberg School of Public Health, discuss the data on COVID-19 and COVID-19 vaccination among HUD-assisted households.

Highlights

  • Between May 2021 and May 2022, an estimated 22.9 percent of HUD-assisted adults reported that they had been previously told by a healthcare provider that they had COVID-19.
  • Nearly 70 percent of HUD-assisted adults reported receiving at least one COVID-19 vaccination between May 2021 and May 2022. Vaccination rates varied significantly by age, region, and race or ethnicity, but there were no observable differences by HUD program type.
  • Approximately 26.8 percent of HUD-assisted adults reported COVID-19 vaccine hesitancy, defined as having never received a COVID-19 vaccine dose and no definitive plans to get one. The most common reasons cited for hesitancy included concern over possible side effects, mistrust of COVID-19 vaccines, mistrust of the government, and concerns regarding vaccine safety.

Background

Approximately 10 million low-income individuals currently receive federal housing assistance, a social safety net program that seeks to limit household spending on rent and utilities. Through a range of different programs including public housing, housing choice vouchers, and multifamily housing, the U.S. Department of Housing and Urban Development (HUD) annually promotes housing stability for more than 4 million households.

The COVID-19 pandemic, with its associated job loss and economic turmoil, highlighted the importance of housing stability. Despite the potential benefits of receiving housing assistance during this chaotic time, HUD-assisted renters experience disproportionally high rates of COVID-19 risk factors, including:

  • High Rates of Chronic Disease. Adults that receive housing assistance have high levels of comorbidities, including being overweight or obese (70.7%), being current smokers (33.5%), or having high blood pressure (37.9%), that place them at higher risk of morbidity and mortality should they contract COVID-19.

  • Large Shares of Older Adults. Nearly 2 million older adults receive federal housing assistance. Age is strongly correlated with worse COVID-19 outcomes.

  • Systemic Racism. The experience of being non-white in the US, due to experiences of systemic racism and discrimination, are further tied with increased COVID-19 risks. Over 75 percent of individuals who receive housing assistance are nonwhite. In addition, recipients of housing assistance frequently live in under-resourced neighborhoods that have been hit particularly hard by the pandemic.

  • Project-Based Housing. Some forms of housing assistance are project based, meaning that a household might live in a multiunit property with shared spaces, including elevators or common spaces, that without proper precautions may allow for rapid COVID-19 transmission.

HUD Efforts To Target Vaccines

Recognizing the need to prioritize targeting efforts for HUD-assisted tenants, on May 5, 2021, HUD Secretary Marcia L. Fudge and U.S. Department of Housing and Human Services (HHS) Secretary Xavier Becerra announced a joint agency effort to increase access to COVID-19 prevention and treatment services, including testing and vaccines, among communities disproportionately affected by the coronavirus, including HUD-assisted households. For example, in June 2021, HUD released a comprehensive COVID-19 vaccinations and testing toolkit. HUD and HHS also directed grantees to leverage community partnerships to promote vaccine access; both agencies provided technical support to achieve equity and prioritized low-income and nonwhite communities for outreach efforts. To learn more about HUD's efforts to target COVID-19 resources, check out the following ArcGIS StoryMap: HUD delivers COVID-19 resources (arcgis.com).

Methods

The U.S. Census Bureau’s Household Pulse Survey (HPS) is an experimental, longitudinal survey designed to quickly capture information about household social and economic experiences during the COVID-19 pandemic. To obtain these estimates, HPS respondent information was linked with HUD administrative data at the individual and household levels for the agency’s largest housing assistance programs. The U.S. Census Bureau reviewed all data products displayed in this article for unauthorized disclosure of confidential information and approved the disclosure avoidance practices applied to this release (CBDRB-FY22-POP001-0086). For more detailed information about this data linkage, please contact Veronica.E.Helms@hud.gov.

Key Findings

Key findings regarding rates of COVID-19 diagnosis, vaccine uptake, and vaccine hesitancy among HUD-assisted adults are highlighted below.

COVID-19 Diagnosis Rate Among HUD-Assisted Adults


Bar graph detailing the percentage of adults reporting a COVID-19 diagnosis by housing status from May 2021 to May 2022.

From May 2021 to May 2022, approximately 22.9 percent (SE: 1.14) of HUD-assisted adults reported a COVID-19 diagnosis, meaning they had been previously told by a healthcare provider that they had COVID-19. The high rate of COVID-19 diagnosis among HUD-assisted adults likely reflects many of the risk factors previously discussed. COVID-19 diagnosis rates among HUD-assisted adults were similar to those of low-income adult renters as a whole after accounting for standard error; 19.9 percent (SE: 0.36) of low-income adult renters self-reported a COVID-19 diagnosis during the same period.

COVID-19 Diagnosis Risk Factors Among HUD-Assisted Adults


Bar graph detailing the percentage of HUD-assisted adults with COVID-19 diagnosis by age category from May 2021 to May 2022.

Several risk factors significantly affected the likelihood that a HUD-assisted adult would report a previous COVID-19 diagnosis.

  • Age. Among HUD-assisted adults, younger HUD-assisted adults experienced higher rates of COVID-19 diagnosis, whereas older HUD-assisted adults had significantly lower rates of COVID-19 diagnosis.

  • HUD Program Type. Rates of COVID-19 diagnosis were similar across the different types of HUD housing programs. No significant differences existed across HUD program categories.

  • Region. Among HUD-assisted adults, no significant differences existed in COVID-19 diagnosis rates by region.

  • Race/Ethnicity. Among HUD-assisted adults, no significant differences existed in COVID-19 diagnosis rates by race or ethnicity.

COVID-19 Vaccine Uptake Among HUD-Assisted Adults


Bar graph detailing the percentage of adults reporting at least one COVID-19 vaccine by housing status from May 2021 to May 2022.

In April 2021, all U.S. adults became eligible for COVID-19 vaccinations, and by May 2021, these vaccines became widely accessible regardless of health insurance status. Between May 2021 and May 2022, approximately 69.9 percent (SE: 1.07) of HUD-assisted adults reported having received at least one COVID-19 vaccination. When compared to low-income adult renters as a whole reported similar rates of COVID-19 vaccination after accounting for standard error: an estimated 72.3 percent (SE: 0.35) of these renters self-reported receiving at least one dose of a COVID-19 vaccine.

Type of COVID-19 Vaccines Among HUD-Assisted Adults

Starting in December 2021, HPS began asking respondents about their COVID-19 vaccine dose brand. Among HUD-assisted adults with at least one dose of the COVID-10 vaccine, approximately half (52.8 percent; SE: 2.35) received the Pfizer-BioNTech vaccine while approximately 38.3 percent (SE: 2.54) received the Moderna vaccine. Approximately 5 percent of HUD-assisted adults received the Johnson & Johnson (Janssen) vaccine. A very small percentage of respondents reported receipt of another, unlisted vaccine.

COVID-19 Vaccine Dosing Among HUD-Assisted Adults

As the vaccine rollout progressed, governments and researchers began recommending booster shots to enhance protection against infection. Among HUD-assisted adults that reported receiving at least one COVID-19 vaccine dose between December 2021 and May 2022, 6.61 percent reported receiving only one shot. Note, however, that approximately 5 percent of HUD-assisted adults reported receiving the Johnson & Johnson vaccine, a single-dose shot. Approximately 53.8 percent (SE: 0.77) of HUD-assisted adults reported receiving two vaccine doses, and approximately 39.6 percent (SE: 2.57) of HUD-assisted adults reported receiving three or more COVID-19 vaccine doses.

COVID-19 Vaccine Hesitancy Rate Among HUD-Assisted Adults

Vaccine hesitancy was defined as having never received a COVID-19 vaccine and having no definitive plans to get one. Between December 2021 and May 2022, approximately 26.8 percent (SE: 1.00) of HUD-assisted adults reported COVID-19 vaccine hesitancy. Low-income adult renters as a whole reported similar rates of vaccine hesitancy when accounting for standard error; an estimated 24.4 percent (SE: 0.36) of these renters reported COVID-19 vaccine hesitancy.

Factors Associated with COVID-19 Vaccine Hesitancy Among HUD-Assisted Adults


Bar graph detailing the percentage of HUD-assisted adults who are COVID-19 vaccine hesitant by age from December 2021 to May 2022.

Several risk factors significantly affected the likelihood that a HUD-assisted adult would report vaccine hesitancy:

  • Age. Among HUD-assisted adults, the relationship between COVID-19 vaccine hesitancy and age is significant (p<0.01). Younger HUD-assisted adults had higher rates of COVID-19 vaccine hesitancy, whereas older HUD-assisted adults had significantly lower rates of COVID-19 hesitancy.

  • HUD Program Type. Rates of COVID-19 vaccine hesitancy are similar across the different HUD program categories.

  • Region. Among HUD-assisted adults, significant differences existed in COVID-19 vaccine hesitancy by region. HUD-assisted adults in the northeast had the lowest rates of hesitancy (18.6%; SE: 1.99), and HUD-assisted adults in the south had the highest rates of vaccine hesitancy (34.1%; SE: 1.75).


  • Bar graph detailing the percentage of HUD-assisted adults who are COVID-19 vaccine hesitant by region from December 2021 to May 2022.

  • Race/Ethnicity. Rates of vaccine hesitancy among HUD-assisted adults also varied significantly by race and ethnicity. The highest rate of vaccine hesitancy occurred among non-Hispanic, black HUD-assisted adults (32.3%; SE: 1.64). Rates among non-Hispanic white and Hispanic HUD-assisted adults were similar, with rates of 22.9 percent (SE: 1.47) and 22.1 percent (SE: 2.56), respectively. Among Asian HUD-assisted adults, only 6.2 percent (SE: 1.92) reported vaccine hesitancy.

Reasons for COVID-19 Vaccine Hesitancy Among HUD-Assisted Adults

Beginning in January 2021, the HPS asked respondents to identify reasons for vaccine hesitancy. The most common reason, reported by 51.3 percent (SE: 2.76) of respondents, was concern about possible vaccine side effects. Mistrust of COVID-19 vaccines was the second most common reason, reported by 40 percent (SE: 2.60) of these respondents. HUD-assisted adults also cited mistrust of government as a reason for vaccine hesitancy (26.6 percent; SE:2.49).

A plan to “wait and see” was another commonly cited reason, reported by 37.2 percent (SE: 2.50) of HUD-assisted adults who were vaccine hesitant. Note that 18.3 percent (SE: 1.77) of HUD-assisted adults who were vaccine hesitant reported their reason as “other,” meaning that their reason for hesitancy was not among the listed options. Finally, a very small percentage of HUD-assisted adults (2.11%; SE: 0.80) reported experiencing difficulty accessing a vaccine, suggesting that

HUD’s outreach efforts were successful in facilitating vaccine access for HUD tenants.

Overall, the high rates of lack of trust in vaccines and in government more broadly together with few reporting logistical barriers suggests the importance of working to build trust to increase vaccine uptake among HUD-assisted tenants.

Source:

U.S. Department of Housing and Urban Development. n.d. “Assisted Housing: National and Local — Picture of Subsidized Households.” Accessed 10 June 2022

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Source:

U.S. Department of Housing and Urban Development. 2021. “Understanding the Numbers: COVID-19 Vaccination Rates and Risk Factors Among HUD-Assisted Families,” webinar, 27 October; U.S. Department of Housing and Urban Development. 2021. “COVID-19 Risk Factors Among HUD-Assisted Renters,” PD&R Edge, 8 February. Accessed 10 June 2022.×

Source:

U.S. Department of Housing and Urban Development. 2017. “A Health Picture of HUD-Assisted Adults, 2006–2012.”×

Source:

U.S. Department of Housing and Urban Development. 2021. “Fact Sheet: HUD and HHS Announce Joint Effort to Increase Access to COVID-19 Vaccinations.” Accessed 10 June 2022.×

Source:

U.S. Department of Housing and Urban Development. 2021. “Fact Sheet: HUD and HHS Announce Joint Effort to Increase Access to COVID-19 Vaccinations.” Accessed 10 June 2022.×

Source:

Sara Heath. 2021. “HHS, HUD Urge Community Health Partnership for COVID Health Equity,” Patient Engagement HIT, 6 May. Accessed 10 June 2022.×

Source:

 HUD administrative data were collected through HUD Form-50058 and HUD Form-50059.×

Source:

Weeks 29 to 45 from HPS.×

Source:

Weeks 29 to 45 from HPS.×

Defined as adults living in a renter household with a self-reported income of less than $25,000. The average income of a HUD-assisted household is approximately $16,000; however, the lowest income threshold in the HPS is less than $25,000, meaning that the low-income comparison group likely has a higher mean household income than the HUD-assisted adult group.×

Source:

American Journal of Managed Care staff. 2021. “A Timeline of COVID-19 Vaccine Developments in 2021,” American Journal of Managed Care, 3 June. Accessed 10 June 2022.×

Source:

Week 40 in the HPS. ×

 
 
Published Date: 14 June 2022