We further identify the persistence of housing hardship within each period (see text box). To better capture the duration of these experiences, we classify housing hardship within each period as persistent , some , or none . Individuals who faced housing hardship in both years of a period are categorized as experiencing persistent hardship , those who reported a spell of hardship in only one year are categorized as experienc- ing some hardship , and those who did not report hardship in either year are categorized as having stable housing (no hardship). 5 , 6
Housing hardship classification Persistent hardship
Experienced housing hardship in both years of a period
Some hardship
Experienced a spell of housing hardship in only one year of a period
Stable housing
Experienced no housing hardship in either year of a period
Our full sample consists of 1,912 individuals in the peak period and 1,745 in the waning period. Of those, 650 met our criteria for having high healthcare need (“high-need”) in the peak period and 688 in the waning period.
Sample size Table 1
Full Sample
High-Need Individuals
Peak Period
1,912 1,745 3,657
650 688
Waning Period
Total* 1,338 * Because of the longitudinal nature of the data, some individuals can appear in both periods, so the total does not represent the number of unique individuals. Why Housing? Housing is a central component of affordability in New York City. Approximately two million New Yorkers are rent burdened, spending more than 30 percent of their income on housing, and concerns over housing costs have become central to city and state policy debates. 7,8 Within this broader landscape, housing hardship rep- resents an important economic barrier that can shape how New Yorkers access and experience healthcare. We focus on housing hardship as a barrier to healthcare because stable housing supports essential aspects of care. A safe and consistent place to live is critical for recovering from medical procedures, managing ill- ness at home, storing medications, and maintaining communication with healthcare providers. Conversely, unsafe or unstable housing—whether due to mold, pests, or recurring inability to afford housing—can lead to health complications that themselves require care, adding strain to individuals already facing elevated health needs. 9 5 For instance, if an individual faced housing hardship in 2021 but not in 2022, they are classified as experiencing some hardship in the peak period. 6 For this analysis, we statistically control for the following demographic indicators: race, gender, age, education level, immigration status, months worked per year, poverty gap, housing tenure, number of children in household, number of seniors in household, and number of working-age adults in household. 7 Koutavas, A., Collyer, S., and Jia, Y. "Spotlight: Housing affordability and the threat of cuts to federal housing assistance programs." 8 Brand, D. Affordable housing takes center stage in New York City mayoral race. 9 Bentley, R., Mason, K., Jacobs, D., Blakely, T., Howden-Chapman, P., Li, A., Adamkiewicz, G., & Reeves, A. “Housing as a social determinant of health: A contemporary framework."
HOW HOUSING IS LINKED TO HEALTHCARE ACCESS AMONG NEW YORKERS SINCE THE PANDEMIC 5
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