Health impact, and economic value, of meeting housing quality standards: a retrospective longitudinal data linkage study
Background: Poor-quality housing adversely affects residents’ health but there is a paucity of high-quality evidence to support this. Objective: This research investigated the health impact of bringing housing to a national quality standard. Design: A natural experiment of improvements to housing qu...
| Main Authors: | , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
NIHR Journals Library
2018-06-01
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| Series: | Public Health Research |
| Subjects: | |
| Online Access: | https://doi.org/10.3310/phr06080 |
| _version_ | 1818276509201203200 |
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| author | Sarah E Rodgers Rowena Bailey Rhodri Johnson Wouter Poortinga Robert Smith Damon Berridge Pippa Anderson Ceri Phillips Simon Lannon Nikki Jones Frank D Dunstan Jonathan Morgan Sandra Y Evans Pam Every Ronan A Lyons |
| author_facet | Sarah E Rodgers Rowena Bailey Rhodri Johnson Wouter Poortinga Robert Smith Damon Berridge Pippa Anderson Ceri Phillips Simon Lannon Nikki Jones Frank D Dunstan Jonathan Morgan Sandra Y Evans Pam Every Ronan A Lyons |
| author_sort | Sarah E Rodgers |
| collection | DOAJ |
| description | Background: Poor-quality housing adversely affects residents’ health but there is a paucity of high-quality evidence to support this. Objective: This research investigated the health impact of bringing housing to a national quality standard. Design: A natural experiment of improvements to housing quality analysed using repeated measures of health-care utilisation and economic outcomes at an individual person level. Setting: Carmarthenshire, UK. Participants: A total of 32,009 residents registered for a minimum of 60 days at 8558 social homes that received housing improvements between January 2005 and March 2015. Interventions: Multiple internal and external housing improvements, including wall and loft insulation, windows and doors, heating system upgrades, new kitchens and bathrooms, garden path safety improvements and electrical system upgrades (adding power sockets, and extractor fans in kitchens and bathrooms). Main outcome measures: Emergency hospital admissions for cardiorespiratory conditions and injuries. Primary health-care utilisation for respiratory and common mental health disorders, emergency department injury attendances and health-care utilisation costs. Data sources: Carmarthenshire County Council home address and intervention records were anonymously linked within the Secure Anonymous Information Linkage databank to demographic information from the Welsh Demographic Service data set; hospital admission data from the Patient Episode Dataset for Wales; primary care contacts and prescribed medications from general practice data; emergency department attendances from the Emergency Department Data Set; and deaths from the Office for National Statistics mortality register. Methods: The study used a longitudinal panel design to examine changes in standard of eight housing cointervention from intervention records, and linked to individuals registered at intervention homes. Health outcomes were obtained retrospectively for each individual in a dynamic cohort and were captured for up to 123 consecutive months. An additional local authority region could not be utilised as a comparator owing to different reporting pressures resulting in the recording of a different intervention. The exposure group for each cointervention was compared with an internal reference group of people living in homes that did not receive the cointervention during their tenancy. A multilevel modelling approach was used to account for repeated observations for individuals living in intervention homes. Counts of health outcomes were analysed using negative binomial regression models to determine the effect of each cointervention that reached housing quality standards during an individual’s period of tenancy, compared with those living in properties that did not. We adjusted for potential confounding factors and for background trends in the regional general population. A cost–consequences analysis was conducted as part of the health economic evaluation. Results: Residents aged ≥ 60 years living in homes in which electrical systems were upgraded were associated with 39% fewer admissions than those living in homes in which they were not [incidence rate ratio (IRR) 0.61, 95% confidence interval (CI) 0.53 to 0.72; p < 0.01]. Reduced admissions were also associated with windows and doors (IRR 0.71, 95% CI 0.63 to 0.81; p < 0.01), wall insulation (IRR 0.75, 95% CI 0.67 to 0.84; p < 0.01) and gardens and estates (IRR 0.73, 95% CI 0.64 to 0.83; p < 0.01) for those living in homes in which these cointervention were upgraded. There were no associations of change in emergency admissions with upgrading heating (IRR 0.91, 95% CI 0.82 to 1.01; p = 0.072), loft insulation (IRR 0.98, 95% CI 0.86 to 1.11; p = 0.695), kitchens (IRR 0.98, 95% CI 0.83 to 1.17; p = 0.843) or bathrooms (IRR 0.93, 95% CI 0.81 to 1.06; p = 0.287). Limitations: There was no randomisation, there were incomplete data on the scale of the intervention for individual households and there were no estimates for the impact of the whole programme. Conclusions: This complex interdisciplinary study found that hospital admissions could be avoided through improving housing quality standards. Future work: At their initiation, future non-health projects should have a built-in evaluation to allow intervention exposures to be randomly allocated to residents, with the simultaneous analysis of multiple health outcomes in one statistical model. Funding: The National Institute for Health Research Public Health Research programme. |
| first_indexed | 2024-12-12T22:46:46Z |
| format | Article |
| id | doaj.art-a83233b1d63a42578dd332953c608877 |
| institution | Directory Open Access Journal |
| issn | 2050-4381 2050-439X |
| language | English |
| last_indexed | 2024-12-12T22:46:46Z |
| publishDate | 2018-06-01 |
| publisher | NIHR Journals Library |
| record_format | Article |
| series | Public Health Research |
| spelling | doaj.art-a83233b1d63a42578dd332953c6088772022-12-22T00:09:11ZengNIHR Journals LibraryPublic Health Research2050-43812050-439X2018-06-016810.3310/phr0608009/3006/02Health impact, and economic value, of meeting housing quality standards: a retrospective longitudinal data linkage studySarah E Rodgers0Rowena Bailey1Rhodri Johnson2Wouter Poortinga3Robert Smith4Damon Berridge5Pippa Anderson6Ceri Phillips7Simon Lannon8Nikki Jones9Frank D Dunstan10Jonathan Morgan11Sandra Y Evans12Pam Every13Ronan A Lyons14Swansea University Medical School, Swansea University, Swansea, UKSwansea University Medical School, Swansea University, Swansea, UKSwansea University Medical School, Swansea University, Swansea, UKWelsh School of Architecture, Cardiff University, Cardiff, UKSchool of Geography and Planning, Cardiff University, Cardiff, UKSwansea University Medical School, Swansea University, Swansea, UKSwansea Centre for Health Economics, College of Human and Health Sciences, Swansea University, Swansea, UKSwansea Centre for Health Economics, College of Human and Health Sciences, Swansea University, Swansea, UKWelsh School of Architecture, Cardiff University, Cardiff, UKWelsh School of Architecture, Cardiff University, Cardiff, UKCochrane Institute of Primary Care and Public Health, School of Medicine, Cardiff University, Cardiff, UKCarmarthenshire County Council, Carmarthen, UKCarmarthenshire County Council, Carmarthen, UKTenant Participation Advisory Services of Wales (TPAS Cymru), Cardiff, UKSwansea University Medical School, Swansea University, Swansea, UKBackground: Poor-quality housing adversely affects residents’ health but there is a paucity of high-quality evidence to support this. Objective: This research investigated the health impact of bringing housing to a national quality standard. Design: A natural experiment of improvements to housing quality analysed using repeated measures of health-care utilisation and economic outcomes at an individual person level. Setting: Carmarthenshire, UK. Participants: A total of 32,009 residents registered for a minimum of 60 days at 8558 social homes that received housing improvements between January 2005 and March 2015. Interventions: Multiple internal and external housing improvements, including wall and loft insulation, windows and doors, heating system upgrades, new kitchens and bathrooms, garden path safety improvements and electrical system upgrades (adding power sockets, and extractor fans in kitchens and bathrooms). Main outcome measures: Emergency hospital admissions for cardiorespiratory conditions and injuries. Primary health-care utilisation for respiratory and common mental health disorders, emergency department injury attendances and health-care utilisation costs. Data sources: Carmarthenshire County Council home address and intervention records were anonymously linked within the Secure Anonymous Information Linkage databank to demographic information from the Welsh Demographic Service data set; hospital admission data from the Patient Episode Dataset for Wales; primary care contacts and prescribed medications from general practice data; emergency department attendances from the Emergency Department Data Set; and deaths from the Office for National Statistics mortality register. Methods: The study used a longitudinal panel design to examine changes in standard of eight housing cointervention from intervention records, and linked to individuals registered at intervention homes. Health outcomes were obtained retrospectively for each individual in a dynamic cohort and were captured for up to 123 consecutive months. An additional local authority region could not be utilised as a comparator owing to different reporting pressures resulting in the recording of a different intervention. The exposure group for each cointervention was compared with an internal reference group of people living in homes that did not receive the cointervention during their tenancy. A multilevel modelling approach was used to account for repeated observations for individuals living in intervention homes. Counts of health outcomes were analysed using negative binomial regression models to determine the effect of each cointervention that reached housing quality standards during an individual’s period of tenancy, compared with those living in properties that did not. We adjusted for potential confounding factors and for background trends in the regional general population. A cost–consequences analysis was conducted as part of the health economic evaluation. Results: Residents aged ≥ 60 years living in homes in which electrical systems were upgraded were associated with 39% fewer admissions than those living in homes in which they were not [incidence rate ratio (IRR) 0.61, 95% confidence interval (CI) 0.53 to 0.72; p < 0.01]. Reduced admissions were also associated with windows and doors (IRR 0.71, 95% CI 0.63 to 0.81; p < 0.01), wall insulation (IRR 0.75, 95% CI 0.67 to 0.84; p < 0.01) and gardens and estates (IRR 0.73, 95% CI 0.64 to 0.83; p < 0.01) for those living in homes in which these cointervention were upgraded. There were no associations of change in emergency admissions with upgrading heating (IRR 0.91, 95% CI 0.82 to 1.01; p = 0.072), loft insulation (IRR 0.98, 95% CI 0.86 to 1.11; p = 0.695), kitchens (IRR 0.98, 95% CI 0.83 to 1.17; p = 0.843) or bathrooms (IRR 0.93, 95% CI 0.81 to 1.06; p = 0.287). Limitations: There was no randomisation, there were incomplete data on the scale of the intervention for individual households and there were no estimates for the impact of the whole programme. Conclusions: This complex interdisciplinary study found that hospital admissions could be avoided through improving housing quality standards. Future work: At their initiation, future non-health projects should have a built-in evaluation to allow intervention exposures to be randomly allocated to residents, with the simultaneous analysis of multiple health outcomes in one statistical model. Funding: The National Institute for Health Research Public Health Research programme.https://doi.org/10.3310/phr06080housing standardsanonymised data linkagehealth service utilisationemergency admissionsrespiratory conditionsmental healthresource allocationbig data |
| spellingShingle | Sarah E Rodgers Rowena Bailey Rhodri Johnson Wouter Poortinga Robert Smith Damon Berridge Pippa Anderson Ceri Phillips Simon Lannon Nikki Jones Frank D Dunstan Jonathan Morgan Sandra Y Evans Pam Every Ronan A Lyons Health impact, and economic value, of meeting housing quality standards: a retrospective longitudinal data linkage study Public Health Research housing standards anonymised data linkage health service utilisation emergency admissions respiratory conditions mental health resource allocation big data |
| title | Health impact, and economic value, of meeting housing quality standards: a retrospective longitudinal data linkage study |
| title_full | Health impact, and economic value, of meeting housing quality standards: a retrospective longitudinal data linkage study |
| title_fullStr | Health impact, and economic value, of meeting housing quality standards: a retrospective longitudinal data linkage study |
| title_full_unstemmed | Health impact, and economic value, of meeting housing quality standards: a retrospective longitudinal data linkage study |
| title_short | Health impact, and economic value, of meeting housing quality standards: a retrospective longitudinal data linkage study |
| title_sort | health impact and economic value of meeting housing quality standards a retrospective longitudinal data linkage study |
| topic | housing standards anonymised data linkage health service utilisation emergency admissions respiratory conditions mental health resource allocation big data |
| url | https://doi.org/10.3310/phr06080 |
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