Household conditions, COVID-19, and equity: Insight from two nationally representative surveys

BACKGROUND: With people across the United States spending increased time at home since the emergence of COVID-19, housing characteristics may have an even greater impact on health. Therefore, we assessed associations between household conditions and COVID-19 experiences. METHODS: We used data from two nationally representative surveys: the Tufts Equity Study (TES; n = 1449 in 2021; n = 1831 in 2022) and the Household Pulse Survey (HPS; n = 147,380 in 2021; n = 62,826 in 2022). In the TES, housing conditions were characterized by heating/cooling methods; smoking inside the home; visible water damage/mold; age of housing unit; and self-reported concern about various environmental factors. In TES and HPS, household size was assessed. Accounting for sampling weights, we examined associations between each housing exposure and COVID-19 outcomes (diagnosis, vaccination) using separate logistic regression models with covariates selected based on an evidence-based directed acyclic graph. RESULTS: Having had COVID-19 was more likely among people who reported poor physical housing condition (odds ratio [OR] = 2.32; 95% confidence interval [CI] = 1.17–4.59; 2021), visible water damage or mold/musty smells (OR = 1.50; 95% CI = 1.10–2.03; 2022), and larger household size (5+ versus 1–2 people; OR = 1.53, 95% CI = 1.34–1.75, HPS 2022). COVID-19 vaccination was less likely among participants who reported smoke exposure inside the home (OR = 0.53; 95% CI = 0.31–0.90; 2022), poor water quality (OR = 0.42; 95% CI = 0.21–0.85; 2021), noise from industrial activity/construction (OR = 0.44; 95% CI = 0.19–0.99; 2022), and larger household size (OR = 0.57; 95% CI = 0.46–0.71; HPS 2022). Vaccination was also positively associated with poor indoor air quality (OR = 1.96; 95% CI = 1.02–3.72; 2022) and poor physical housing condition (OR = 2.27; 95% CI = 1.01–5.13; 2022). Certain heating/cooling sources were associated with COVID-19 outcomes. CONCLUSIONS: Our study found poor housing conditions associated with increased COVID-19 burden, which may be driven by systemic disparities in housing, healthcare, and financial access to resources during the COVID-19 pandemic.