Background We investigated tenant healthcare utilisation associated with upgrading 8558 council houses to a national quality standard. Homes received multiple internal and external improvements and were analysed using repeated measures of healthcare utilisation.
Methods The primary outcome was emergency hospital admissions for cardiorespiratory conditions and injuries for residents aged 60 years and over. Secondary outcomes included each of the separate conditions, for tenants aged 60 and over, and for all ages. Council home address and intervention records for eight housing cointerventions were anonymously linked to demographic data, hospital admissions and deaths for individuals in a dynamic cohort. Counts of health events were analysed using multilevel regression models to investigate associations between receipt of each housing improvement, adjusting for potential confounding factors and regional trends.
Results Residents aged 60 years and over living in homes when improvements were made were associated with up to 39% fewer admissions compared with those living in homes that were not upgraded (incidence rate ratio=0.61, 95% CI 0.53 to 0.72). Reduced admissions were associated with electrical systems, windows and doors, wall insulation, and garden paths. There were small non-significant reductions for the primary outcome associated with upgrading heating, adequate loft insulation, new kitchens and new bathrooms.
Conclusion Results suggest that hospital admissions can be avoided through improving whole home quality standards. This is the first large-scale longitudinal evaluation of a whole home intervention that has evaluated multiple improvement elements using individual-level objective routine health data.
- longitudinal studies
- public health
- health services
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Funding Additional technical and computing support for this study was provided by the Farr Institute at Swansea University, made possible by the following grant: Centre for the Improvement of Population Health through E-records Research (CIPHER) and Farr Institute capital enhancement. CIPHER and the Farr Institute are funded by Arthritis Research UK, the British Heart Foundation, Cancer Research UK, the Chief Scientist Office (Scottish Government Health Directorates), the Economic and Social Research Council, the Engineering and Physical Sciences Research Council, the Medical Research Council, the National Institute for Health Research, the National Institute for Social Care and Health Research (Welsh Government) and the Wellcome Trust (grant reference MR/K006525/1). We were also supported by HDR-UK; a joint investment led by the Medical Research Council, together with theNational Institute for Health Research (England), the Chief Scientist Office(Scotland), Health and Care Research Wales, Health and Social Care Research andDevelopment Division (Public Health Agency, Northern Ireland), the Engineeringand Physical Sciences Research Council, the Economic and Social ResearchCouncil, the British Heart Foundation and Wellcome. The work had the support of the Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), a UKCRC Public Health Research Centre of Excellence. Funding from the British Heart Foundation, Cancer Research UK, the Economic and Social Research Council (RES-590–28–0005), the Medical Research Council, the Welsh Government and the Wellcome Trust (WT087640MA), under the auspices of the UKCRC, is gratefully acknowledged.
Competing interests WP and SL received funding from Carmarthenshire County Council to conduct a health impact survey study from 2009 to 2016.
Patient consent Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Access to the raw data may be attained by submitting an Information Governance Review Panel application following instructions available from www.saildatabank.com. Programming code may be requested from the corresponding author. The study protocol is available from the NIHR at https://www.journalslibrary.nihr.ac.uk/programmes/phr/09300602/#/. A cohort profile paper was published in the International Journal of Epidemiology: https://academic.oup.com/ije/article/43/1/52/730313.
Presented at Some of these results were first presented at the Lancet Public Health conference, Cardiff 2016
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