Clair Amy, Loopstra Rachel, Reeves Aaron, McKee Martin, Dorling Danny, Stuckler David
Department of Sociology, University of Oxford, Manor Road Building, Manor Road, Oxford OX1 3UQ, UK.
European Observatory on Health Systems and Policies, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK.
SSM Popul Health. 2016 Dec;2:306-316. doi: 10.1016/j.ssmph.2016.05.006.
Although the recent Great Recession had its origins in the housing sector, the short-term health impact of the housing crisis is not well understood. We used longitudinal data to evaluate the impact of housing payment problems on health status among home-owners and renters in 27 European states. Multi-level and fixed-effects models were applied to a retrospective cohort drawn from the EU Statistics on Income and Living Conditions survey of employed persons, comprising those without housing arrears in the base year 2008 and followed through to 2010 (=45,457 persons, 136,371 person-years). Multi-variate models tested the impact of transitioning into housing payment arrears on self-reported health (0-worst to 4-best), adjusting for confounders including age, sex, baseline health, and individual fixed effects. Transitioning into housing arrears was associated with a significant deterioration in the health of renters (-0.09 units, 95% CI -0.05 to -0.13), but not owners (0.00, 95% CI -0.05 to 0.06), after adjusting for individual fixed effects. This effect was independent of and greater than the impact of job loss for the full sample (-0.05, 95% CI -0.002 to -0.09). The magnitude of this association varied across countries; the largest adverse associations were observed for renters in Belgium, Austria, and Italy. There was no observed protective association of differing categories of social protection or of the housing regulatory structure for renters. Women aged 30 and over who rented appeared to have worse self-reported health when transitioning into arrears than other groups. Renters also fared worse in those countries where house prices were escalating. We therefore find that housing payment problems are a significant risk factor for worse-self reported health in persons who are renting their homes. Future research is needed to understand potential sources of health resilience among renters, especially at a time when housing prices are rising in many European states.
尽管近期的大衰退起源于房地产行业,但住房危机对健康的短期影响尚未得到充分理解。我们利用纵向数据评估了27个欧洲国家中住房支付问题对房主和租客健康状况的影响。多层次和固定效应模型应用于从欧盟收入和生活条件就业人员调查中抽取的回顾性队列,该队列包括2008年基准年无住房欠款且随访至2010年的人员(=45457人,136371人年)。多变量模型测试了陷入住房支付欠款对自我报告健康状况(0-最差至4-最佳)的影响,并对包括年龄、性别、基线健康状况和个体固定效应在内的混杂因素进行了调整。在调整个体固定效应后,陷入住房欠款与租客健康状况的显著恶化相关(-0.09分,95%置信区间-0.05至-0.13),但与房主无关(0.00,95%置信区间-0.05至0.06)。这一效应独立于且大于整个样本中失业的影响(-0.05,95%置信区间-0.002至-0.09)。这种关联的程度在不同国家有所不同;在比利时、奥地利和意大利,租客的负面关联最为明显。未观察到不同类别的社会保护或住房监管结构对租客有保护关联。30岁及以上的租房女性在陷入欠款时自我报告的健康状况似乎比其他群体更差。在房价不断上涨的国家,租客的情况也更糟。因此,我们发现住房支付问题是租房者自我报告健康状况变差的一个重要风险因素。需要未来的研究来了解租客健康恢复力的潜在来源,尤其是在许多欧洲国家房价上涨之际。