Department of Public Health and Policy, University of Liverpool, Liverpool, UK.
Health Data Research-UK, Swansea University, Swansea, UK.
J Epidemiol Community Health. 2018 Oct;72(10):896-903. doi: 10.1136/jech-2017-210370. Epub 2018 Jun 20.
We investigated tenant healthcare utilisation associated with upgrading 8558 council houses to a national quality standard. Homes received multiple internal and external improvements and were analysed using repeated measures of healthcare utilisation.
The primary outcome was emergency hospital admissions for cardiorespiratory conditions and injuries for residents aged 60 years and over. Secondary outcomes included each of the separate conditions, for tenants aged 60 and over, and for all ages. Council home address and intervention records for eight housing cointerventions were anonymously linked to demographic data, hospital admissions and deaths for individuals in a dynamic cohort. Counts of health events were analysed using multilevel regression models to investigate associations between receipt of each housing improvement, adjusting for potential confounding factors and regional trends.
Residents aged 60 years and over living in homes when improvements were made were associated with up to 39% fewer admissions compared with those living in homes that were not upgraded (incidence rate ratio=0.61, 95% CI 0.53 to 0.72). Reduced admissions were associated with electrical systems, windows and doors, wall insulation, and garden paths. There were small non-significant reductions for the primary outcome associated with upgrading heating, adequate loft insulation, new kitchens and new bathrooms.
Results suggest that hospital admissions can be avoided through improving whole home quality standards. This is the first large-scale longitudinal evaluation of a whole home intervention that has evaluated multiple improvement elements using individual-level objective routine health data.
我们调查了租户医疗保健的使用情况，这些租户与将 8558 所议会住房升级到国家质量标准有关。这些房屋进行了多次内部和外部改进，并使用医疗保健使用的重复测量进行了分析。
主要结果是 60 岁及以上居民因心肺疾病和伤害而紧急住院。次要结果包括 60 岁及以上租户和所有年龄段租户的每种单独疾病。在动态队列中，将 8 个住房干预措施的理事会住房地址和干预记录匿名链接到个人的人口统计数据、住院和死亡记录。使用多水平回归模型分析健康事件的计数，以调查接受每种住房改善措施与调整潜在混杂因素和区域趋势之间的关联。
与居住在未升级房屋的居民相比，居住在改善房屋中的 60 岁及以上居民的住院人数减少了 39%（发病率比=0.61，95%置信区间 0.53 至 0.72）。电气系统、门窗、墙壁隔热和花园小径与减少住院有关。与升级供暖、充足的阁楼隔热、新厨房和新浴室相关的主要结果有较小的非显著降低。
结果表明，通过提高整体房屋质量标准可以避免住院治疗。这是对整个房屋干预措施的首次大规模纵向评估，该评估使用个体水平的客观常规健康数据评估了多个改进因素。
