Background National housing quality standards are being applied throughout the UK. A housing improvement programme was delivered through a local authority to bring nearly 9000 homes up to the Welsh Housing Quality Standard (WHQS). Homes received multiple elements, including new kitchens, bathrooms, windows and doors, insulation, and heating and electrical systems, through an eight-year rolling work programme. The study aimed to determine the impacts of the different housing improvements on hospital emergency admissions for all residents.

Methods Intervention homes, council homes that received at least one element of work, were data linked to individual health records of residents. Counts of admissions relating to respiratory and cardiovascular conditions, and falls and burns, were obtained retrospectively for each individual in a dynamic housing cohort (January 2005–March 2015). The intervention cohort criterion was for someone to have lived in any one of the intervention homes for at least three months within the intervention period. Counts were captured for up to 123 consecutive months for 32 009 individuals in the intervention cohort and analysed using a multilevel approach to account for repeated observations for individuals, nested within geographic areas. Negative Binomial regression models were constructed to determine the effect for each element of work on emergency admissions for those people living in homes in receipt of the intervention element, compared to those living in homes that did not meet quality standards at that time. We adjusted for background trends in the regional general population, as well as for other confounding factors.

Results People of all ages had 34% fewer admissions for cardiovascular and respiratory conditions, and fall and burn injuries while living in homes when the electrical systems were upgraded, compared to the reference group (IRR=0.66, 95% CI 0.58–0.76). Reduced admissions were also found for new windows and doors (IRR=0.78, 0.70–0.87), wall insulation (IRR=0.80, 0.73–0.87) and garden paths (IRR=0.81, 0.73–0.90). There were no associations of change in emergency admissions with upgrading heating (IRR=0.92, 0.85–1.01), loft insulation, (IRR=1.02, 0.93–1.13), kitchens (IRR=1.01, 0.87–1.18), or bathrooms (IRR=0.99, 0.87–1.13).

Conclusion Improving housing to national standards reduces the number of emergency admissions to hospital for residents. Strengths of the data linkage approach included the retrospective collection of complete baseline and follow up using routine data for a long-term intervention, and large scale regional adjustment.