Abstract
Residential segregation shapes access to health-promoting resources and drives health inequities in the United States. Connecticut's Section 8-30g incentivizes municipalities to develop a housing stock that is at least 10% affordable housing. We used this implicit target to project the impact of increasing affordable housing across all 169 Connecticut municipalities on all-cause mortality among low-income residents. We modeled six ambient environmental exposures: fine particulate matter (PM(2.5)), ozone (O(3)), nitrogen dioxide (NO(2)), summertime daily maximum heat index, greenness, and road traffic noise. We allocated new affordable housing to reach the 10% target in each town and simulated random movement of low-income households into new units using an inverse distance weighting penalty. We then quantified exposure changes and used established exposure-response functions to estimate deaths averted stratified by four ethnoracial groups: Asian, Hispanic or Latino, non-Hispanic Black, and non-Hispanic White. We quantified racialized segregation by computing a multi-group index of dissimilarity at baseline and post-simulation. Across 1,000 simulations, in one year (2019) we found on average 169 (95% CI: 84, 255) deaths averted from changes in greenness, 71 (95% CI: 49, 94) deaths averted from NO(2), 9 (95% CI: 4, 14) deaths averted from noise, and marginal impacts from other exposures, with the highest rates of deaths averted observed among non-Hispanic Black and non-Hispanic White residents. Multi-group index of dissimilarity declined on average in all eight Connecticut counties post-simulation. Sensitivity analyses simulating a different population movement strategy and modeling a different year (2018) yielded consistent results. Strengthening desegregation policy may reduce deaths from environmental exposures among low-income residents. Further research should explore non-mortality impacts and additional mechanisms by which desegregation may advance health equity.