(P24-030-23) Diabetes Distress or Housing Instability: Which Is a More Salient Psychosocial Stressor for Low-Income People With Diabetes in the United States?

Objectives: Housing instability (HI) imposes significant negative psychosocial effects on Americans and poses as a potential social determinant in the management of diabetes. Diabetes distress (DD), the distress specific to diabetes self-management (DSM), is linked with suboptimal insulin regulation and increased blood glucose. Emerging studies suggest that cognitive appraisal, or a person’s perception of their own health, may influence their DSM. This study’s objective was to examine relationships between HI and DD in the United States (US) and the role of cognitive appraisal in DSM.

Methods: We used the 2021 National Health Interview Survey, a cross-sectionally, nationally representative survey of non-institutionalized adults. We defined HI as persons with < 30% of the 2021 US median income (US MI) not receiving any housing assistance. We used multivariate logistic regressions to examine relationships between HI and DD adjusting for demographic (race/ethnicity, sex, urban/rural area, US region), socioeconomic (food insecurity, receiving Supplemental Nutrition Assistance Program, receiving income assistance), psychological (anxiety), and diabetes-related (taking insulin, taking diabetic pills) factors. We performed sensitivity analyses defining HI using < 50% and < 80% thresholds of the 2021 US MI. All analyses were adjusted for nationally representative weights. We report odds ratios (OR) with 95% confidence intervals assuming α < 0.05.

Results: We found that 50.81% of the surveyed population (n=29,482 unweighted; N=253,157,754 weighted), reported DD while 33.6% experienced HI. Multivariate regression models showed that persons with HI were 49% less likely to experience DD (OR: 0.51 [0.33, 0.77] p=0.002) adjusting for listed covariates. Results remained consistent irrespective of the threshold of HI applied albeit not significant.

Conclusions: Our findings suggest that, in a person’s cognitive appraisal of their DSM, HI may be a more salient psychosocial stressor than DD. If so, negative coping strategies may result in DSM disengagement, as a person’s attention is diverted to care for other social determinants. Health interventions aimed at mitigating DD among people with very low incomes should consider the role of psychological determinants of health.

Funding Sources: There are no funding sources.