Department of Environmental and Occupational Health, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA.
Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA.
Environ Health. 2022 May 24;21(1):56. doi: 10.1186/s12940-022-00866-8.
Substandard housing conditions and hazardous indoor environmental exposures contribute to significant morbidity and mortality worldwide. Housing indices that capture the multiple dimensions of healthy housing are important for tracking conditions and identifying vulnerable households. However, most indices focus on physical deficiencies and repair costs and omit indoor environmental exposures, as few national data sources routinely collect this information.
We developed a multidimensional Housing and Environmental Quality Index (HEQI) based on the World Health Organization's Housing and Health Guidelines and applied it to the 2019 American Housing Survey (AHS). The HEQI consisted of ten domains associated with poor health: household fuel combustion, dampness and mold, pests and allergens, lead paint risk, high indoor temperatures, low indoor temperatures, household crowding, injury hazards, inadequate water and sanitation, and ventilation. We evaluated the validity and performance of the HEQI against three housing characteristics (i.e., year built, monthly rent costs, unit satisfaction rating) and two established indices (i.e., Adequacy Index, Poor Quality Index).
Approximately 79% (92 million) of U.S. households reported at least one HEQI domain associated with poor health (mean per household: 1.3; range: 0,8). Prevalent domains included household fuel combustion (61.4%), dampness and mold (15.9%), inadequate water and sanitation (14.3%), and injury hazards (11.9%). Pests and allergens, low indoor temperatures, and injury hazards were consistently associated with older homes, lower rent costs, and lower unit satisfaction. Compared to established housing indices, the HEQI captured four new environmental domains which enabled the identification of 57.7 million (63%) more households with environmental risk factors like mold, cockroaches, crowding, household fuel combustion, and higher building leakage.
Indoor environmental exposures are prevalent in U.S. households and not well-captured by existing housing indices. The HEQI is a multidimensional tool that can be used to monitor indoor environmental exposures and housing quality trends in the U.S. Some domains, including radon, pesticides, asbestos, noise, and housing accessibility could not be assessed due to the lack of available data in the AHS. The mounting evidence linking residential environmental exposures with adverse health outcomes underscore the need for this data in the AHS and other national surveys.
住房条件不达标和室内环境危害暴露是导致全球范围内发病率和死亡率居高不下的重要因素。捕捉健康住房多维度的住房指数对于跟踪住房条件和识别弱势家庭非常重要。然而，大多数指数主要关注物理缺陷和维修成本，而忽略了室内环境暴露，因为很少有国家数据源会定期收集这些信息。
我们根据世界卫生组织的《住房与健康指南》制定了一个多维的住房和环境质量指数（HEQI），并将其应用于 2019 年美国住房调查（AHS）。HEQI 由十个与健康不良相关的领域组成：家庭燃料燃烧、潮湿和霉菌、害虫和过敏原、含铅油漆风险、室内高温、室内低温、家庭拥挤、伤害危险、供水和卫生设施不足以及通风。我们根据三个住房特征（即房屋建造年份、月租金成本、单位满意度评分）和两个既定指数（即充足性指数、劣质指数）评估了 HEQI 的有效性和性能。
大约 79%（9200 万户）的美国家庭报告了至少一个与健康不良相关的 HEQI 领域（每户平均：1.3；范围：0-8）。常见的领域包括家庭燃料燃烧（61.4%）、潮湿和霉菌（15.9%）、供水和卫生设施不足（14.3%）和伤害危险（11.9%）。害虫和过敏原、室内低温和伤害危险与较旧的房屋、较低的租金成本和较低的单位满意度相关。与既定的住房指数相比，HEQI 还捕获了四个新的环境领域，这使得确定了 5770 万户（63%）有更多环境风险因素的家庭，这些因素包括霉菌、蟑螂、拥挤、家庭燃料燃烧和更高的建筑渗漏。
室内环境暴露在美国家庭中很普遍，而现有的住房指数并没有很好地捕捉到这些暴露。HEQI 是一种多维工具，可以用于监测美国的室内环境暴露和住房质量趋势。由于 AHS 中缺乏可用数据，一些领域，包括氡、农药、石棉、噪音和住房可及性，无法进行评估。越来越多的证据表明，住宅环境暴露与不良健康结果有关，这突显了 AHS 和其他国家调查中需要这些数据。
