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North Carolina Value:
Percentage of households with one or more adults age 65 and older for which housing costs are 30% or more of household income
North Carolina Rank:
Percentage of households with one or more adults age 65 and older for which housing costs are 30% or more of household income
20.6% - 26.2%
26.3% - 28.5%
28.6% - 31.6%
31.7% - 36.6%
36.7% - 42.8%
US Value: 33.3%
Top State(s): West Virginia: 20.6%
Bottom State(s): California: 42.4%
Definition: Percentage of households with one or more adults age 65 and older for which housing costs are 30% or more of household income
Data Source and Years(s): U.S. Census Bureau, American Community Survey, 1-Year Dataset, 2024
Suggested Citation: America's Health Rankings analysis of U.S. Census Bureau, American Community Survey, 1-Year Dataset, United Health Foundation, AmericasHealthRankings.org, accessed 2026.
Households that spend more than 30% of their income on housing are considered cost-burdened. Cost-burdened older adults may have difficulty affording other basic needs such as health care, food and heat. One study found that individuals who had difficulty affording housing were more likely to report fair or poor health, certain chronic conditions and nonadherence to prescription medication due to cost. Further, those with lower socioeconomic status experience lower life expectancies than those with a higher socioeconomic status, a gap that has widened over time in the United States.
Between 2000 and 2020, housing prices in the United States rose by more than 20%, outpacing median household income. Transitioning into retirement during this period of increasing income inequality makes older adults especially vulnerable to economic hardship. Many older adults rely on external programs to fund their housing — Social Security payments account for one-third of the income reported by households headed by an adult age 65 or older. In 2023, 22.6 million American households spent more than 30% of their income on housing, and the percentage of cost-burdened households headed by someone age 65 or older reached 58%. Approximately half of these households spent more than 50% of their income on housing, classifying them as severely cost-burdened.
The prevalence of cost-burdened older adults is higher among:
Research has found that older adults prefer to stay in their homes for as long as possible, but many residences lack the accessibility features that aging adults need. Programs designed to support home maintenance, such as the Older Adults Home Modification Grant Program, play a crucial role in enhancing safety and accessibility within the homes of low-income older adults. Additionally, Healthy Homes programs at state and local levels have been found to improve health by remedying unhealthy housing conditions, including lead exposures, inadequate ventilation and excess moisture.
More collaboration between the housing and public health sectors is needed to promote healthy home environments and better integrate health care into housing systems, particularly for those with chronic health needs. Keeping those options affordable is of significant concern to the health and life expectancy of older adults in the U.S. Rental vouchers, subsidized housing and utility assistance programs can help cost-burdened individuals afford safe and healthy housing:
Healthy People 2030 has a goal to reduce the proportion of families that spend more than 30% of their income on housing.
Berlin, Loren, ed. Housing America’s Older Adults 2023. Cambridge, MA: Joint Center for Housing Studies of Harvard University, 2023. https://www.jchs.harvard.edu/sites/default/files/reports/files/Harvard_JCHS_Housing_Americas_Older_Adults_2023.pdf.
Berlin, Loren, ed. The State of the Nation’s Housing 2025. Cambridge, MA: Joint Center for Housing Studies of Harvard University, 2025. https://www.jchs.harvard.edu/sites/default/files/reports/files/Harvard_JCHS_The_State_of_the_Nations_Housing_2025.pdf.
Braveman, Paula, Mercedes Dekker, Susan Egerter, Tabashir Sadegh-Nobari, and Craig Pollack. Housing and Health. Exploring the Social Determinants of Health: Issue Brief #7. Robert Wood Johnson Foundation Commission to Build a Healthier America, May 2011. https://www.rwjf.org/en/library/research/2011/05/housing-and-health.html.
Gibson, Marcia, Mark Petticrew, Clare Bambra, Amanda J. Sowden, Kath E. Wright, and Margaret Whitehead. “Housing and Health Inequalities: A Synthesis of Systematic Reviews of Interventions Aimed at Different Pathways Linking Housing and Health.” Health & Place 17, no. 1 (January 2011): 175–84. https://doi.org/10.1016/j.healthplace.2010.09.011.
National Academies of Sciences, Engineering, and Medicine. The Growing Gap in Life Expectancy by Income: Implications for Federal Programs and Policy Responses. Washington, D.C.: National Academies Press, 2015. https://doi.org/10.17226/19015.
Pollack, Craig, Susan Egerter, Tabashir Sadegh-Nobari, Mercedes Dekker, and Paula Braveman. Where We Live Matters for Our Health: The Links Between Housing and Health. Issue Brief 2: Housing and Health. Robert Wood Johnson Foundation Commission to Build a Healthier America, September 2008. http://www.commissiononhealth.org/PDF/e6244e9e-f630-4285-9ad7-16016dd7e493/Issue Brief 2 Sept 08 - Housing and Health.pdf.
Pollack, Craig Evan, Beth Ann Griffin, and Julia Lynch. “Housing Affordability and Health Among Homeowners and Renters.” American Journal of Preventive Medicine 39, no. 6 (December 2010): 515–21. https://doi.org/10.1016/j.amepre.2010.08.002.
Pynoos, Jon. “The Future of Housing for the Elderly: Four Strategies That Can Make a Difference.” Edited by Robert B Hudson. Public Policy & Aging Report 28, no. 1 (April 17, 2018): 35–38. https://doi.org/10.1093/ppar/pry006.
Sandel, Megan, and Matthew Desmond. “Investing in Housing for Health Improves Both Mission and Margin.” JAMA 318, no. 23 (December 19, 2017): 2291–92. https://doi.org/10.1001/jama.2017.15771.
Vega, William A., and Steven P. Wallace. “Affordable Housing: A Key Lever to Community Health for Older Americans.” American Journal of Public Health 106, no. 4 (April 2016): 635–36.https://doi.org/10.2105/AJPH.2015.303034.
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