Melbourne School of Population and Global Health, The University of Melbourne, Australia; Department of Public Health, Policy and Systems, University of Liverpool, UK.
Department of Public Health, Policy and Systems, University of Liverpool, UK.
Soc Sci Med. 2024 Jun;351:116939. doi: 10.1016/j.socscimed.2024.116939. Epub 2024 May 10.
Housing insecurity is an escalating problem in the UK but there is limited evidence about its health impacts. Using nationally representative panel data and causally focussed methods, we examined the effect of insecure housing on mental health, sleep and blood pressure, during a period of government austerity.
We used longitudinal survey data (2009-2019, n = 11,164 individuals with annual data) from the UK Household Longitudinal Study. Outcomes were probable common mental disorder (GHQ-12), sleep disturbance due to worry, and new diagnoses of hypertension. The primary exposure was housing payment problems in the past year. Using doubly robust marginal structural models with inverse probability of treatment weights, we estimated absolute and relative health effects of housing payment problems, and population attributable fractions. In stratified analyses we assessed potentially heterogeneous impacts across the population, and potential modifying effects of government austerity measures. A negative control analysis was conducted to detect bias due to unmeasured confounding.
Housing payment problems were associated with a 2.5 percentage point increased risk of experiencing a common mental disorder (95% CI 1.1%, 3.8%) and 2.0% increased risk of sleep disturbance (95% CI 0.7%, 3.3%). Estimates were larger for renters, younger people, less educated, households with children, and people living in areas most affected by austerity-related cuts to housing support services. We did not find consistent evidence for an association with hypertension (risk difference = 0.4%; 95% CI -0.1%, 0.9%). The negative control analysis was not indicative of unmeasured confounding.
Housing payment problems were associated with worse mental health and sleep disturbance in a large UK sample. Households at risk of falling into rent or mortgage arrears need more support, especially in areas where housing support services have been diminished. Substantial investment is urgently needed to improve supply of social and affordable housing.
住房无保障是英国日益严重的问题，但有关其对健康影响的证据有限。本研究使用具有代表性的面板数据和因果聚焦方法，在政府紧缩时期，研究了住房无保障对心理健康、睡眠和血压的影响。
我们使用了英国家庭纵向研究（2009-2019 年，n=11164 名个体，每年都有数据）中的纵向调查数据。结局为一般健康问卷 12 项（GHQ-12）得分较高的常见精神障碍、因担忧而导致的睡眠障碍和高血压的新诊断。主要暴露为过去一年的住房支付问题。采用具有治疗逆概率加权的双重稳健边际结构模型，我们估计了住房支付问题对健康的绝对和相对影响，并计算了人群归因分数。在分层分析中，我们评估了人群中潜在的异质影响以及政府紧缩措施的潜在调节作用。进行了负向对照分析以检测未测量混杂引起的偏倚。
住房支付问题与经历常见精神障碍的风险增加 2.5 个百分点（95%CI，1.1%-3.8%）和睡眠障碍风险增加 2.0%（95%CI，0.7%-3.3%）相关。对于租户、年轻人、受教育程度较低的人、有子女的家庭以及生活在受与住房支持服务削减相关的紧缩措施影响最大的地区的人，估计值更大。我们没有发现与高血压相关的一致证据（风险差=0.4%；95%CI，-0.1%-0.9%）。负向对照分析并未表明存在未测量的混杂。
在英国的大样本中，住房支付问题与心理健康状况恶化和睡眠障碍有关。有陷入租金或抵押贷款拖欠风险的家庭需要更多的支持，特别是在住房支持服务减少的地区。迫切需要大量投资来改善社会和经济适用房的供应。
