Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
Am J Prev Med. 2010 Dec;39(6):515-21. doi: 10.1016/j.amepre.2010.08.002.
Although lack of affordable housing is common in the U.S., few studies have examined the association between housing affordability and health.
Using quasi-experimental methods, the aim of this study was to examine whether housing affordability is linked to a number of important health outcomes, controlling for perceptions of neighborhood quality, and determining whether this association differs by housing tenure (renting versus owning).
Data from the 2008 Southeastern Pennsylvania Household Health Survey, a telephone-based survey of 10,004 residents of Philadelphia and its four surrounding counties, were analyzed. The association between housing affordability and health outcomes was assessed using propensity score methods to compare individuals who reported living in unaffordable housing situations to similar individuals living in affordable ones.
Overall, 48.4% reported difficulty paying housing costs. People living in unaffordable housing had increased odds of poor self-rated health (AOR=1.75, 95% CI=1.33, 2.29); hypertension (AOR=1.34, 95% CI=1.07, 1.69); arthritis (AOR=1.92, 95% CI=1.56, 2.35); cost-related healthcare nonadherence (AOR=2.94, 95% CI=2.04, 4.25); and cost-related prescription nonadherence (AOR=2.68, 95% CI=1.95, 3.70). There were no significant associations between housing affordability and heart disease, diabetes, asthma, psychiatric conditions, being uninsured, emergency department visits in the past year, obesity, and being a current smoker. Renting rather than owning a home heightened the association between unaffordable housing and self-rated health (AOR=2.55, 95% CI=1.93, 3.37 for renters and not significant among homeowners) and cost-related healthcare nonadherence (AOR=4.74, 95% CI=3.05, 7.35 for renters and AOR=1.99, 95% CI=1.15, 3.46 for homeowners).
The financial strain of unaffordable housing is associated with trade-offs that may harm health. Programs that target housing affordability for both renters and homeowners may be an important means for improving health.
尽管在美国，住房负担能力不足是一个普遍现象，但很少有研究探讨住房负担能力与健康之间的关系。
本研究采用准实验方法，旨在检验住房负担能力是否与一系列重要的健康结果相关，同时控制对邻里质量的感知，并确定这种关联是否因住房保有形式（租赁与自有）而异。
对来自费城及其周边四个县的 10004 名居民进行的基于电话的 2008 年宾夕法尼亚州东南部家庭健康调查（Southeastern Pennsylvania Household Health Survey）的数据进行了分析。采用倾向评分方法比较报告住房负担过重和住房负担可承受的个体，评估住房负担能力与健康结果之间的关联。
总体而言，48.4%的人报告难以支付住房费用。居住在住房负担过重地区的人自评健康状况较差的可能性更高（OR=1.75，95%CI=1.33，2.29）；高血压（OR=1.34，95%CI=1.07，1.69）；关节炎（OR=1.92，95%CI=1.56，2.35）；与费用相关的医疗保健不依从（OR=2.94，95%CI=2.04，4.25）；与费用相关的处方不依从（OR=2.68，95%CI=1.95，3.70）。住房负担能力与心脏病、糖尿病、哮喘、精神疾病、没有保险、过去一年急诊就诊、肥胖和当前吸烟之间没有显著关联。与自有住房相比，租赁住房会加剧住房负担过重与自评健康状况较差（OR=2.55，95%CI=1.93，3.37 为租户，而房主不显著）和与费用相关的医疗保健不依从（OR=4.74，95%CI=3.05，7.35 为租户，OR=1.99，95%CI=1.15，3.46 为房主）之间的关联。
住房负担能力不足带来的经济压力与可能损害健康的权衡取舍有关。针对租户和房主的住房负担能力计划可能是改善健康的重要手段。
