Umishio Wataru, Kiuchi Sakura, Ojima Toshiyuki, Saito Masashige, Hanazato Masamichi, Aida Jun
Department of Architecture and Building Engineering, School of Environment and Society, Institute of Science Tokyo, Meguro, Tokyo, Japan.
Frontier Research Institute for Interdisciplinary Sciences, Tohoku University, Sendai, Miyagi, Japan.
BMJ Public Health. 2025 Sep 8;3(2):e003073. doi: 10.1136/bmjph-2025-003073. eCollection 2025.
The WHO Housing and Health Guidelines have highlighted the impact of housing quality on cardiovascular diseases (CVDs), including pathways such as cold-induced hypertension. Major factors influencing housing quality include architectural type (detached houses vs flats) and tenure (owned vs rented), but few studies have examined their effects on CVDs.
46 850 occupants were included during the follow-up period from 1 January 2012 to 31 December 2017 in the Japan Gerontological Evaluation Study. By linking survey data with cause-of-death records, the Kaplan-Meier curves were constructed. Competing risk regression models were applied to calculate the subdistribution HRs (SHRs) for cardiovascular mortality risks across housing statuses, adjusted for demographics, socioeconomic factors and lifestyle behaviours. Sex-stratified analyses and Cox regression analyses were also conducted to calculate the HRs.
A total of 38 731 participants (46.6% men) were analysed, with a mean age of 73.6 years and a median follow-up period of 2091 days. The cardiovascular mortality rate was 3.97 per 1000 person-years, with 2.3% experiencing CVD-related deaths. The Kaplan-Meier curve indicated higher cardiovascular mortality for those living in rental flats and owned detached houses compared with those in owned flats. Competing risk regression models indicated a significantly higher risk of cardiovascular deaths among occupants living in rental flats compared with those in owned flats (SHR=1.78; 95% CI 1.05-3.02). For men, the risk was notably higher (SHR=2.32; 95% CI 1.13-4.75), though not statistically significant in women. Sensitivity analyses using Cox regression supported these findings, showing higher risk estimates for men (HR=2.36; 95% CI 1.16-4.82).
Rental housing and detached houses are likely to have lower temperatures and greater temperature instabilities, raising blood pressure and increasing CVDs. Improving housing quality can contribute to cardiovascular health at the population level.
世界卫生组织的住房与健康指南强调了住房质量对心血管疾病（CVDs）的影响，包括诸如寒冷诱发高血压等途径。影响住房质量的主要因素包括建筑类型（独立式住宅与公寓）和居住权（自有与租赁），但很少有研究考察它们对心血管疾病的影响。
在2012年1月1日至2017年12月31日的随访期间，日本老年学评估研究纳入了46850名居住者。通过将调查数据与死亡原因记录相联系，构建了Kaplan-Meier曲线。应用竞争风险回归模型计算不同住房状况下心血管疾病死亡风险的亚分布风险比（SHRs），并对人口统计学、社会经济因素和生活方式行为进行了调整。还进行了性别分层分析和Cox回归分析以计算风险比。
共分析了38731名参与者（46.6%为男性），平均年龄73.6岁，中位随访期为2091天。心血管疾病死亡率为每1000人年3.97例，2.3%的人死于心血管疾病相关原因。Kaplan-Meier曲线表明，与自有公寓居住者相比，租赁公寓和自有独立式住宅居住者的心血管疾病死亡率更高。竞争风险回归模型表明，与自有公寓居住者相比，租赁公寓居住者的心血管疾病死亡风险显著更高（SHR = 1.78；95%CI 1.05 - 3.02）。对于男性，风险显著更高（SHR = 2.32；95%CI 1.13 - 4.75），尽管在女性中无统计学意义。使用Cox回归的敏感性分析支持了这些发现，显示男性的风险估计更高（HR = 2.36；95%CI 1.16 - 4.82）。
租赁住房和独立式住宅可能温度较低且温度波动较大，会升高血压并增加心血管疾病风险。改善住房质量有助于在人群层面促进心血管健康。
