Poor housing conditions are associated with illness. For example, roof leaks can lead to mold that triggers asthma. Many US public housing developments are aging and in disrepair. The Rental Assistance Demonstration (RAD) program supports building improvements and promotes wellbeing of residents through private-sector funding incentivized by tax credits.

Are RAD-funded renovations in Fresno County (CA) public housing associated with changes in health, using Medicaid healthcare utilization? We used data of 125,731 Medicaid patients who resided in renovated public housing (RAD-PH), non-renovated public housing (Non-RAD), or non-public housing (Non-PH) in Fresno 2017-2019. We selected housing-sensitive conditions – respiratory infections, injury, and mental disorders – identified in the records with ICD10 codes. We used Cox regression models to compare one-year follow-up healthcare visits for these conditions with weighted propensity scores applied across each cohort to balance sample characteristics across groups.

After applying normalized propensity score weights, RAD residents (32%) had a lower weighted prevalence of visits for respiratory disorders compared to non-RAD (43%) and non-PH residents (38%; p<.001). We saw similar patterns for respiratory infections and chronic lung disease (Non-RAD PH: 69%; Non-PH: 70%; RAD: 41%; p<.001) and injury (Non-RAD PH: 12%; Non-PH: 11%; RAD: 7%; p<.001). In contrast, RAD residents had a higher prevalence of visits for mental disorders (32%) than Non-RAD PH (17%) and non-PH residents (12%; p<.001). Weighted Cox regression models showed that, compared to RAD, non-PH residents had a lower hazard of mental health visits (HR=0.48, p=.012). In contrast, both non-PH (HR=1.59, p=.032) and non-RAD residents (HR=1.58, p=.035) had a higher hazard of visits for respiratory infections and chronic lung disease compared to RAD residents. Our results suggest initiatives to support public housing improvements can reduce healthcare utilization.