Severe Housing Cost Burden*
In the model
Use County Health Rankings’ model of health to explore the measures that influence how long and how well we live.
Percentage of households that spend 50% or more of their household income on housing. The 2022 County Health Rankings used data from 2016-2020 for this measure.
There is a strong and growing evidence base linking stable and affordable housing to health. As housing costs have outpaced local incomes, households not only struggle to acquire and maintain adequate shelter, but also face difficult trade-offs in meeting other basic needs. When the majority of a paycheck goes toward the rent or mortgage, it makes it hard to afford doctor visits, healthy foods, utility bills, and reliable transportation to work or school.[1-4] This can, in turn, lead to increased stress levels and emotional strain.[5,6]
Data and methods
American Community Survey, 5-year estimates
The American Community Survey (ACS) is a nationwide survey designed to provide communities with a fresh look at how they are changing. It is a critical element in the Census Bureau's reengineered decennial census program. The ACS collects and produces population and housing information every year instead of every ten years, and publishes both one-year and five-year estimates. The County Health Rankings use American Community Survey data to obtain measures of social and economic factors.
Key Measure Methods
Severe Housing Cost Burden is a percentage
Severe Housing Cost Burden is the percentage of households that spend 50% or more of their household income on housing.
Severe Housing Cost Burden is not identical to the measure used as part of Severe Housing Problems
In order to provide users with the most recent data, Severe Housing Cost Burden is calculated from the American Community Survey, rather than downloading it from the Comprehensive Housing Affordability Strategy (CHAS) Dataset. Although both measures rely on the same underlying data, the numerator and denominator are defined somewhat differently. Given the difference in measure definitions, and the additional years of data used for this measure, there may be differences in these values of these two measures that seem incompatible. For example, a county can have a higher Severe Housing Cost Burden rate than its Severe Housing Problems rate.
The numerator is the total number of households in a county that spend 50% or more of their household income on housing.
The denominator is the total occupied housing units for which housing cost burden is computed in a county.
Can This Measure Be Used to Track Progress
This measure can be used to track progress with some caveats. It is important to note that the estimate provided in the County Health Rankings is a 5-year average. However, for counties with a population greater than 20,000, single-year estimates can be obtained from the resource listed below.
This measure can be calculated for census tracts, census block groups, and income and broken out by owners/renters using tables B25074 (denominator) and B25095 (numerator). These tables can be accessed at https://data.census.gov/cedsci/.
 Kushel MB, Gupta R, Gee L, & Haas JS. Housing instability and food insecurity as barriers to health care among low-income Americans. Journal of general internal medicine. 2006; 21(1):71-77.
 Ma CT, Gee L, & Kushel MB. Associations between housing instability and food insecurity with health care access in low-income children. Ambulatory Pediatrics. 2008; 8(1):50-57.
 Long SK. Hardship among the uninsured: choosing among food, housing, and health insurance. The Urban Institute. 2003. http://webarchive.urban.org/publications/310775.html
 Levy H, & DeLeire T. What do people buy when they don't buy health insurance and what does that say about why they are uninsured? National Bureau of Economic Research. 2003; w9826.
 Hiscock R, Kearns A, MacIntyre S, & Ellaway A. Ontological security and psycho-social benefits from the home: Qualitative evidence on issues of tenure. Housing, theory and society, 2001; 18(1-2): 50-66.
 Dunn JR. Housing and health inequalities: review and prospects for research. Housing studies. 2000; 15(3), 341-366.