Housing insecurity and health: a marginal structural model analysis of the impact of housing payment problems and forced moves on mental health, sleep and hypertension in UK adults, 2009-2019



Mason, Kate ORCID: 0000-0001-5020-5256, Alexiou, Alexandros, Li, Ang and Taylor-Robinson, David ORCID: 0000-0002-5828-7724
(2023) Housing insecurity and health: a marginal structural model analysis of the impact of housing payment problems and forced moves on mental health, sleep and hypertension in UK adults, 2009-2019. [Preprint]

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Abstract

<h4>ABSTRACT</h4> <h4>Background</h4> Housing insecurity is an escalating problem in the UK. Limited empirical evidence exists from which to draw reliable causal inferences about the impact of insecure housing on health. Using nationally representative panel data and causally focussed methods, we examined the effect of insecure housing on mental health, sleep disturbance and cardiovascular health, during a period of government austerity. <h4>Methods</h4> We used longitudinal survey data (2009-2019) from the UK Household Longitudinal Study. Health outcomes included probable common mental disorder; sleep disturbance due to worry; and new diagnoses of hypertension. The primary exposure was housing payment problems in the past 12 months. Using doubly robust marginal structural models) with inverse probability of treatment weights, we estimated absolute and relative health effects of housing payment problems, and population attributable fractions. We performed stratified analyses to assess potentially heterogeneous impacts across the population, and the potential modifying effects of austerity measures in the UK. <h4>Findings</h4> The average absolute effect of housing payment problems was a 2.5 percentage point increased risk of experiencing a common mental disorder (95% CI 1.1%, 3.8%) and 2.0% increased risk of sleep disturbance (95% CI 0.7%, 3.3%). Effects were larger among renters, younger people, less educated, and households with children. Effects were also larger among people living in areas most affected by austerity-related cuts to housing support services. Evidence for a cardiovascular health impact was weak (95% CI -0.1%, 1.2%). <h4>Interpretation</h4> Housing payment problems were associated with worse mental health and sleep disturbance in a large UK sample. Households at risk of falling into rent or mortgage arrears need more support, especially in areas where housing services have been diminished. Rapid and substantial investment is needed to improve supply of social and affordable housing.

Item Type: Preprint
Uncontrolled Keywords: Mental Health, Sleep Research, Behavioral and Social Science, Clinical Research, Mental health, 3 Good Health and Well Being
Divisions: Faculty of Health and Life Sciences
Faculty of Health and Life Sciences > Institute of Population Health
Depositing User: Symplectic Admin
Date Deposited: 15 Jan 2024 08:33
Last Modified: 12 Apr 2024 12:56
DOI: 10.1101/2023.11.27.23299030
Open Access URL: https://www.medrxiv.org/content/10.1101/2023.11.27...
Related URLs:
URI: https://livrepository.liverpool.ac.uk/id/eprint/3177833