Vásquez-Vera Hugo, Rodríguez-Sanz Maica, Palència Laia, Borrell Carme
Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain.
Agència de Salut Pública de Barcelona, Barcelona, Spain.
J Urban Health. 2016 Apr;93(2):312-30. doi: 10.1007/s11524-016-0030-4.
Housing instability has been shown to be related to poorer health outcomes in various studies, mainly in the USA and UK. Affected individuals are more prone to psychiatric (e.g., major depression, anxiety) and physical disorders (e.g., hypertension). This situation has deteriorated with the onset of the economic crisis. One of the most affected countries is Spain, which has high rates of foreclosure and eviction that continue to rise. In response, a civil movement, The Platform for People Affected by Mortgages (PAH), works to provide solutions to its members affected by foreclosure and advocates for the right to decent housing. The aims of this study ware to describe and compare the health status of PAH members from Catalonia to a sample of the general population and to analyze the association between health status and mortgage status, foreclosure stage, and other socioeconomic variables, among members of the PAH. We conducted a cross-sectional study using a self-administered online questionnaire (2014) administered to 905 PAH members in Catalonia (>18 years; 559 women and 346 men). Results were compared with health indicators from The Health Survey of Catalonia 2013 (n = 4830). The dependent variables were poor mental health (GHQ 12 ≥ 3), and poor self-reported health (fair or poor). All analyses were stratified by sex. We computed age-standardized prevalence and prevalence ratios of poor mental and self-reported health in both samples. We also analyzed health outcomes among PAH members according to mortgage status (mortgage holders or guarantors), stage of foreclosure, and other socioeconomic variables by computing prevalence ratios from robust Poisson regression models. The prevalence of poor mental health among PAH members was 90.6 % in women and 84.4 % in men, and 15.5 and 10.2 % in the general population, respectively. The prevalence of poor self-reported health was 55.6 % in women and 39.4 % in men from the PAH, and 19.2 and 16.1 % in the general population, respectively. These health inequalities were independent of socioeconomic status. The prevalence of poor mental health was higher among individuals in the non-payment stage of foreclosure than among those who were up to date with their payments (e.g., PRc = 1.16 [95 % CI 1.04-1.28]). In contrast, self-reported poor health was more prominent in later stages of foreclosure, such as in post-eviction without dation in payment stage in men (PRc = 2.24 [95 %CI = 1.35-3.72]). We observed a considerably higher prevalence of poor mental and self-reported health among male and female PAH members than in the general population. Public policies that tackle housing instability and its consequences are urgently needed in Spain.
在各类研究中，住房不稳定已被证明与较差的健康结果相关，主要是在美国和英国。受影响的个体更容易患精神疾病（如重度抑郁症、焦虑症）和身体疾病（如高血压）。随着经济危机的爆发，这种情况恶化了。受影响最严重的国家之一是西班牙，该国的止赎和驱逐率居高不下且仍在上升。作为回应，一场公民运动——受抵押贷款影响者平台（PAH），致力于为受止赎影响的成员提供解决方案，并倡导体面住房的权利。本研究的目的是描述和比较加泰罗尼亚PAH成员与普通人群样本的健康状况，并分析PAH成员中健康状况与抵押状况、止赎阶段及其他社会经济变量之间的关联。我们进行了一项横断面研究，使用自填式在线问卷（2014年）对加泰罗尼亚的905名PAH成员（年龄>18岁；559名女性和346名男性）进行调查。结果与2013年加泰罗尼亚健康调查（n = 4830）的健康指标进行比较。因变量为心理健康状况差（一般健康问卷12项得分≥3）和自我报告的健康状况差（一般或差）。所有分析均按性别分层。我们计算了两个样本中心理健康状况差和自我报告健康状况差的年龄标准化患病率及患病率比。我们还通过稳健泊松回归模型计算患病率比，根据抵押状况（抵押持有人或担保人）、止赎阶段及其他社会经济变量分析PAH成员的健康结果。PAH成员中，女性心理健康状况差患病率为90.6%，男性为84.4%，而普通人群中分别为15.5%和10.2%。PAH成员中自我报告健康状况差的患病率，女性为55.6%，男性为39.4%，而普通人群中分别为19.2%和16.1%。这些健康不平等与社会经济地位无关。处于止赎未付款阶段的个体心理健康状况差的患病率高于按时付款者（例如，患病率比=1.16 [95%置信区间1.04 - 1.28]）。相比之下，自我报告的健康状况差在止赎后期更为突出，如男性在驱逐后无付款交割阶段（患病率比=2.24 [95%置信区间=1.35 - 3.72]）。我们观察到，PAH成员中男性和女性心理健康状况差和自我报告健康状况差的患病率显著高于普通人群。西班牙迫切需要解决住房不稳定及其后果的公共政策。
