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Abstract
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BACKGROUND: Previous research has shown two-way associations between rental tenure, poorer housing quality, and health outcomes, but little research has looked at relative housing contributions to health outcomes.
AIMS: We investigated whether tenure and/or dwelling condition were associated with housing-sensitive hospitalizations and whether any association differed by income.
METHOD: Using a data set of housing characteristics matched to hospitalization records, rental tenure data, and income quintiles, we modeled differences in housing-sensitive hospitalization rates by ecological-level tenure and housing condition, controlling for age-group and mean temperatures.
RESULTS: There were clear associations between income, tenure, and house condition, and winter-associated hospitalization risk. In the adjusted model, the largest risk differences were associated with neighborhoods with low income (risk ratio [RR] = 1.48) and high rental tenure (RR = 1.41). There was a nonsignificant difference for housing condition (RR = 1.04).
DISCUSSION: Rental tenure and poor housing condition were risks for housing-sensitive hospitalization, but the association with income was stronger. Higher income households may be better able to offset quality and tenure-related health risks. This research illustrates the inverse housing law: Those most vulnerable, with most need for good-quality housing, are least likely to have it. Income inequity is inbuilt in tenure, quality, and health burden relationships.
CONCLUSION: These findings suggest that measures to address health inequities should include improvements to both tenure security and housing quality, particularly in low-income areas. However, policymakers aiming to reduce overall hospitalization rates should focus their efforts on reducing fuel poverty and improving the affordability of quality housing.
Language: en |