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Housing affordability effects on physical and mental health: household survey in a population with the world’s greatest housing affordability stress
  1. Roger Yat-Nork Chung1,
  2. Gary Ka-Ki Chung1,
  3. David Gordon2,
  4. Jonathan Ka-Long Mak1,
  5. Ling-Fei Zhang1,
  6. Dicken Chan1,
  7. Francisco Tsz Tsun Lai1,
  8. Hung Wong3,
  9. Samuel Yeung-Shan Wong1
  1. 1 JC School of Public Health and Primary Care, The Chinese University of Hong Kong, New Territories, Hong Kong
  2. 2 School for Policy Studies, University of Bristol, Bristol, UK
  3. 3 Department of Social Work, Chinese University of Hong Kong, New Territories, Hong Kong
  1. Correspondence to Dr Roger Yat-Nork Chung, Jockey Club School of Public Health and Primary Care, Chinese University of Hong Kong, New Territories, Hong Kong; rychung{at}


Background We examined the association of housing affordability with physical and mental health in Hong Kong, where there is a lack of related research despite having the worst housing affordability problem in the world, considering potential mediating effect of deprivation.

Methods A stratified random sample of 1978 Hong Kong adults were surveyed. Housing affordability was defined using the residual-income (after housing costs) approach. Health-related quality of life was assessed by the Short-Form Health Survey version 2 (SF-12v2), from which the physical component summary (PCS) and mental component summary (MCS) measures were derived. Multivariable linear regressions were performed to assess associations of housing affordability with PCS and MCS scores, adjusting for sociodemographic, socioeconomic and lifestyle factors. Mediation analyses were also conducted to assess the mediating role of deprivation on the effect of housing affordability on PCS or MCS.

Results Dose–response relationships were observed between housing affordability and mean PCS score (β (95% CI) compared with the highest affordable fourth quartile: −2.53 (−4.05 to −1.01), −2.23 (−3.54 to −0.92), −0.64 (−1.80 to 0.51) for the first, second and third quartiles, respectively) and mean MCS score (β (95% CI): −3.87 (−5.30 to –2.45), −2.35 (−3.59 to −1.11), −1.28 (−2.40 to –0.17) for the first, second and third quartiles, respectively). Deprivation mediated 34.3% of the impact of housing unaffordability on PCS and 15.8% of that on MCS.

Conclusions Housing affordability affects physical and mental health, partially through deprivation, suggesting that housing policies targeting deprived individuals may help reduce health inequality in addition to targeting the housing affordability problem.

  • deprivation
  • health inequalities
  • housing
  • poverty

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  • RY-NC and GK-KC are co-first authors.

  • Twitter @rogerynchung

  • Contributors RY-NC oversaw the whole study and was responsible for literature review, study design, data collection, data interpretation and write-up of the manuscript; GK-KC was mainly responsible for literature review, data analysis, data interpretation and write-up of the manuscript; DG contributed to the data analysis, data interpretation and commenting on write-up; JK-LM contributed to write-up of the manuscript; L-FZ contributed to literature review and write-up of the manuscript; DC contributed to data analysis and data interpretation; FTTL contributed to data interpretation and commenting on write-up; SY-SW participated in the study design, data collection and data interpretation; HW was responsible for study design and data collection. All authors read and approved the final manuscript.

  • Funding This work was supported by a Grant from the Central Policy Unit of the Government of the Hong Kong Special Administrative Region and the Research Grants Council of the Hong Kong Special Administrative Region, China (Project No. 4003-SPPR-11).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval This study has been approved by the Survey and Behavioural Research Ethics Committee of the Chinese University of Hong Kong in June 2012.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No data are available.

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