An older adult’s risk of dying from cardiovascular disease is significantly linked to their type of housing, according to a growing body of research that positions residential circumstances as a critical public health issue. Studies are increasingly demonstrating that factors such as owning versus renting, living in a detached house versus an apartment, and the physical condition of a home can profoundly influence heart and blood vessel health, leading to disparate outcomes in mortality.
This connection extends beyond the four walls of a home to encompass the stability, affordability, and safety of one’s living situation. The constant stress of housing insecurity, the quality of the neighborhood environment, and exposure to harmful pollutants within a residence all contribute to cardiovascular risk. A scientific statement from the American Heart Association underscores these links, highlighting that substandard living conditions are associated with higher rates of heart attack, stroke, and heart failure. These findings suggest that improving housing is not just a social or economic issue, but a direct intervention for public health.
The Physical Home Environment as a Risk Factor
The literal structure and atmosphere of a home play a direct role in cardiovascular health. Poor housing quality—often characterized by structural deterioration, insufficient heating or cooling, and dampness—creates conditions that can elevate disease risk. For example, living in a home with inadequate temperature control can lead to higher blood pressure. Likewise, exposure to indoor cardiotoxic pollutants such as mold, lead from old paint, and secondhand smoke is strongly associated with an increased likelihood of developing cardiovascular disease.
Studies have consistently found that adults living in older, public, or low-income housing are more likely to suffer from cardiovascular ailments. The physical deterioration of these environments often means greater exposure to these harmful elements. Substandard housing conditions also affect mental health, which is an established factor in the health of the heart and blood vessels for both children and adults. The American Heart Association notes that targeted improvements, such as enhancing indoor air quality and reducing dampness, have been shown to lower blood pressure, a primary risk factor for heart attacks and strokes.
Impact of Housing Tenure and Type
A Japanese Cohort Study
Specific research highlights the nuances of how both housing type and ownership status relate to mortality. A 6-year cohort study in Japan involving nearly 39,000 individuals examined the combined effect of living in detached houses versus flats and owning versus renting. The findings revealed a significantly higher risk of cardiovascular death among certain groups based on their housing status. For men, living in a rented flat was associated with a more than twofold increase in the risk of cardiovascular death compared to those living in owned flats. This suggests that the combination of apartment living and renting creates a uniquely vulnerable situation, although the precise reasons require further study.
Renters vs. Homeowners
In the United States, scholars consistently find that renters report poorer health outcomes than homeowners, a disparity that appears to widen with age. An analysis using data from the Health and Retirement Study found that older adults who rent face higher cardiometabolic risk, a conclusion based on biomarkers for inflammation, cardiovascular health, and metabolic function. While homeowners often have a socioeconomic advantage, researchers found that poor housing conditions and financial strain independently contribute to this elevated risk. Renters are more commonly exposed to adverse conditions like mold, pests, and cold temperatures. The ongoing stress related to housing affordability and instability is a key factor in the poorer health seen among renters, as they remain vulnerable to rising costs while many older homeowners have paid off their mortgages.
Neighborhood and Community Influences
The environment outside the home is a powerful predictor of cardiovascular well-being. Studies consistently show that individuals living in economically distressed neighborhoods with high rates of poverty and unemployment have a higher incidence of risk factors like obesity, diabetes, and hypertension. Consequently, they also face a greater risk of stroke and death from cardiovascular events. Residential segregation by race and ethnicity further compounds these issues by limiting access to affordable, high-quality housing in well-resourced communities.
The process of gentrification, where more affluent residents move into and renovate lower-income neighborhoods, can displace long-term residents and make it harder to find affordable, safe housing. Furthermore, the foreclosure crisis of 2007–2010 provided stark evidence of neighborhood-level impacts; areas at high risk for foreclosure saw higher rates of high blood pressure and cholesterol among Hispanic residents, while middle-aged Black residents in those areas experienced more heart attacks and strokes. Conversely, positive neighborhood features can be protective. Higher levels of greenness, for instance, are associated with lower rates of Type 2 diabetes, heart attack, and heart failure.
The Cascade of Housing Insecurity
Chronic housing insecurity creates a cascade of negative effects that directly undermine cardiovascular health. According to Mario Sims, who chaired the writing group for the American Heart Association’s scientific statement, this instability can severely impact a person’s ability to manage their health. The constant stress may disrupt proper eating habits, prevent quality sleep, and make it difficult to schedule regular medical care or afford prescriptions.
These factors contribute to the inadequate treatment and control of key cardiovascular risk factors such as high blood pressure, high cholesterol, and tobacco use. For example, among homeless and housing-insecure adults, smoking rates are exceptionally high at 70–80%, and smoking is attributed to 60% of cardiovascular disease deaths in this population. These unhealthy behaviors are often used as coping mechanisms for the psychosocial stressors that accompany housing instability, creating a vicious cycle of poor health and precarious living situations.
Broader Implications for Public Health
The accumulated evidence makes a strong case for treating housing as a fundamental pillar of public and cardiovascular health. The American Heart Association’s scientific statement urges a shift in perspective, calling for multi-level housing interventions to be integrated into efforts to reduce health disparities, particularly for under-resourced communities. Simply addressing individual behaviors is not enough when the environments in which people live actively harm their health.
Improving housing conditions is a direct pathway to better health outcomes. By ensuring that housing is stable, affordable, safe, and of high quality, communities can mitigate many of the chronic stressors and environmental exposures that drive cardiovascular disease. This includes policies that promote equitable housing opportunities, prevent displacement, and invest in neighborhood infrastructure that supports health, such as parks and accessible grocery stores. Ultimately, a healthy heart often begins with a healthy home.
