Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario, M5T 3M7, Canada; Department of Health, Aging & Society, McMaster University, Hamilton, Ontario, Canada.
Soc Sci Med. 2024 Mar;345:116672. doi: 10.1016/j.socscimed.2024.116672. Epub 2024 Feb 13.
While comparative studies reported that generous welfare state improves population health, they did not take into account the roles of housing as a cornerstone of welfare state. To reduce knowledge gaps, this study aims to estimate (a) the link between housing affordability stress and mortality rate due to external causes and (b) the moderating effects of housing regime on such association.
Using country level panel data from the databases of the Organisation for Economic Co-operation and Development (OECD), fixed effects were performed to estimate the effects of housing costs to income ratio on mortality rates due to external causes (accidents, intentional self-harm, and assault). Also, we tested whether housing regimes moderate the association between housing cost burden and mortality rate.
An increased level of housing cost burden predicted mortality rates due to accidents and intentional self-harm. Such association was pronounced for countries with higher rates of homeownership and limited access to market self-help. In addition, when homeownership rates and debt-to-income ratios are taken into account as time-varying variables, the elevated mortality risks associated with both increased housing cost burden and higher homeownership are mitigated in countries where debt relative to income increases.
Our findings suggest that different housing systems shape divergent patterns of mortality risks associated with housing affordability stress. Future studies may wish to incorporate housing in macro comparative studies on population health.
尽管比较研究报告称，慷慨的福利国家制度改善了人口健康状况，但它们没有考虑到住房作为福利国家制度基石的作用。为了减少知识差距，本研究旨在评估：(a)住房负担能力压力与外部原因导致的死亡率之间的关系；(b)住房制度对此类关联的调节作用。
利用经济合作与发展组织（OECD）数据库中的国家层面面板数据，采用固定效应模型来估计住房成本与收入比对外部原因（意外事故、故意自残和袭击）导致的死亡率的影响。此外，我们还测试了住房制度是否调节了住房成本负担与死亡率之间的关联。
住房成本负担水平的增加预示着意外事故和故意自残导致的死亡率上升。对于住房自有率较高且市场自助获取受限的国家，这种关联更为明显。此外，当将住房自有率和债务与收入比作为时变变量考虑时，在债务相对于收入增加的国家，与住房成本负担增加和住房自有率升高相关的死亡率升高风险得到缓解。
我们的研究结果表明，不同的住房制度塑造了与住房负担能力压力相关的不同的死亡率风险模式。未来的研究可能希望将住房纳入人口健康的宏观比较研究中。
