Li Yuxi, Singh Ankur, Bentley Rebecca
Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie St, Carlton VIC, 3053, Australia.
Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Melbourne, Australia.
J Urban Health. 2024 Dec;101(6):1259-1269. doi: 10.1007/s11524-024-00925-0. Epub 2024 Nov 1.
Housing is a critical social determinant of children's health. While individual pathways between housing and health are well evidenced, there has been less attention on the co-occurrence of housing disadvantages. We aim to identify typologies of children's housing disadvantage and describe the health inequities they generate. A cross-sectional latent class analysis (LCA) was conducted on 4355 Australian children aged 4 to 5 years who participated in the Longitudinal Study of Australian Children. Nine binary indicators-dwelling tenure, external condition, affordability, stability, crowding, cleanliness, fuel poverty, and noise exposure-were used to generate latent housing typologies. Generalized linear models with robust standard errors described disparities in quality of life, injury, disability, and health service use across these housing typologies. Four distinct housing typologies were identified in this cohort: "good condition, affordable, and secure" (60%); "insecure" (11%); "crowded" (24%); and "unsuitable" (5%). Unsuitable housing, characterized by crowding, poor external conditions, and noise exposure, was more likely to be occupied by single-parent families, low-income households, and be headed by parents with low levels of education. Children in unsuitable housing lagged on quality of life indicators at preschool age (e.g., by 8.0 points on emotional functioning, 95% CI - 10.6, - 5.5), and underutilized primary healthcare services (e.g., prevalence ratio 0.76 for GP services, 95% CI 0.67, 0.87), compared to children in good quality housing. This finding supports the case for early intervention strategies that account for children's housing circumstances.
住房是影响儿童健康的关键社会因素。虽然住房与健康之间的个体关联路径已有充分证据,但住房劣势的共同出现却较少受到关注。我们旨在确定儿童住房劣势的类型,并描述其所产生的健康不平等现象。对4355名4至5岁参与澳大利亚儿童纵向研究的澳大利亚儿童进行了横断面潜在类别分析(LCA)。使用九个二元指标——居住权、外部条件、可负担性、稳定性、拥挤程度、清洁程度、燃料贫困和噪音暴露——来生成潜在住房类型。采用具有稳健标准误的广义线性模型描述了这些住房类型在生活质量、伤害、残疾和医疗服务使用方面的差异。在该队列中确定了四种不同的住房类型:“条件良好、负担得起且安全”(60%);“不安全”(11%);“拥挤”(24%);“不合适”(5%)。不合适的住房,其特点是拥挤、外部条件差和有噪音暴露,更有可能由单亲家庭、低收入家庭居住,且户主受教育程度低。与居住在优质住房中的儿童相比,居住在不合适住房中的儿童在学龄前的生活质量指标上滞后(例如,情绪功能方面落后8.0分,95%置信区间为-10.6,-5.5),并且初级医疗服务利用不足(例如,全科医生服务的患病率比为0.76,95%置信区间为0.67,0.87)。这一发现支持了考虑儿童住房情况的早期干预策略。