Severe housing cost burden*
Percentage of households that spend 50% or more of their household income on housing.
The 2020 County Health Rankings used data from 2014-2018 for this measure.
Reason for Including
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]
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 was calculated from the American Community Survey, rather than downloading it from the Comprehensive Housing Affordability Dataset. Although both rely on the same underlying data, the numerator and denominator are defined somewhat differently. Given that definitional difference, and the additional years of data used for this measure, there may be differences in these values 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 50.0 percent 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.
Years of Data Used
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.
This measure can be calculated for census tracts, census block groups, and income and broken out by owners/renters using tables B25074 and B25095. These tables can be accessed at https://data.census.gov/cedsci/.
 Kushel, M. B., Gupta, R., Gee, L., & Haas, J. S. (2006). Housing instability and food insecurity as barriers to health care among low-income Americans. Journal of general internal medicine, 21(1), 71-77.
 Ma, C. T., Gee, L., & Kushel, M. B. (2008). Associations between housing instability and food insecurity with health care access in low-income children. Ambulatory Pediatrics, 8(1), 50-57.
 Long, S. K. (2003). Hardship among the uninsured: choosing among food, housing, and health insurance.
 Levy, H., & DeLeire, T. (2003). What do people buy when they don't buy health insurance and what does that say about why they are uninsured? (No. w9826). National Bureau of Economic Research.
 Hiscock, R., Kearns, A., MacIntyre, S., & Ellaway, A. (2001). Ontological security and psycho-social benefits from the home: Qualitative evidence on issues of tenure. Housing, theory and society, 18(1-2), 50-66.
 Dunn, J. R. (2000). Housing and health inequalities: review and prospects for research. Housing studies, 15(3), 341-366.