标题：Mortgage Delinquency and Changes in Access to Health Resources and Depressive Symptoms in a Nationally Representative Cohort of Americans Older Than 50 Years
摘要：Objectives. We evaluated associations between mortgage delinquency and changes in health and health-relevant resources over 2 years, with data from the Health and Retirement Study, a longitudinal survey representative of US adults older than 50 years. Methods. In 2008, participants reported whether they had fallen behind on mortgage payments since 2006 (n = 2474). We used logistic regression to compare changes in health (incidence of elevated depressive symptoms, major declines in self-rated health) and access to health-relevant resources (food, prescription medications) between participants who fell behind on their mortgage payments and those who did not. Results. Compared with nondelinquent participants, the mortgage-delinquent group had worse health status and less access to health-relevant resources at baseline. They were also significantly more likely to develop incident depressive symptoms (odds ratio [OR] = 8.60; 95% confidence interval [CI] = 3.38, 21.85), food insecurity (OR = 7.53; 95% CI = 3.01, 18.84), and cost-related medication nonadherence (OR = 8.66; 95% CI = 3.72, 20.16) during follow-up. Conclusions. Mortgage delinquency was associated with significant elevations in the incidence of mental health impairments and health-relevant material disadvantage. Widespread mortgage default may have important public health implications. Following the dramatic increase in subprime lending that began in 2003, 1 foreclosure rates increased rapidly through 2009, with 2.21% of all US homes—a total of more than 2.8 million properties—in some stage of foreclosure during that year. 2 The rise in mortgage default and foreclosure may threaten population health. Home ownership, a marker of wealth as well as a concrete material resource, is associated with better health, 3 – 6 whereas financial strain is associated with worse health and higher mortality. 7 – 9 Like other sources of financial strain, mortgage delinquency likely affects health through multiple mechanisms, including psychological stress and disrupted access to essential material goods and services, such as food and health care. 10 , 11 Mortgage foreclosure also carries disruption associated with moving such as dislocation from home and social ties. By forcing families to sever and reestablish attachments to their homes, communities, and social relationships, mortgage default and foreclosure may be particularly alienating and detrimental to psychosocial well-being. 10 , 12 Therefore, the material, social, and symbolic upheaval of mortgage default and foreclosure may distinguish these experiences from other types of financial strain. 4 , 13 A recent cross-sectional study found that clients of a mortgage counseling agency in Philadelphia, Pennsylvania, who were undergoing mortgage foreclosure had higher rates of depression, hypertension, and heart disease, as well as a higher prevalence of cost-related health care and prescription nonadherence, than did the general population. 14 The study also found that poor health and health-related debt were associated with being in foreclosure. A second cross-sectional study, conducted in 2008 in the 4 states with the highest foreclosure rates, also identified markedly poorer health status among homeowners in default or foreclosure than in all other housing groups (nondelinquent homeowners and renters). 15 Longitudinal research is necessary to establish whether housing foreclosure simply occurs more frequently among people with poor health or whether foreclosure actually predicts health declines. 16 We investigated whether mortgage delinquency was associated with decreases in health and access to health-relevant resources over a 2-year period in a nationally representative cohort of Americans older than 50 years.
