Association of Promoting Housing Affordability and Stability With Improved Health Outcomes: A Systematic Review.
Association of Promoting Housing Affordability and Stability With Improved Health Outcomes: A Systematic Review.
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DOI：
10.1001/jamanetworkopen.2022.39860
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发表时间：
2022-11-01
影响因子：
13.8
通讯作者：
Shekelle, Paul G.
中科院分区：
文献类型：
--
作者：
Chen, Katherine L.;Miake-Lye, Isomi M.;Begashaw, Meron M.;Zimmerman, Frederick J.;Larkin, Jody;McGrath, Emily L.;Shekelle, Paul G.
通过促进住房负担能力和稳定性来预防住房不安全的干预措施是否与改善健康结果相关？这项对26项随机试验和观察性研究的系统回顾发现，预防住房不安全的干预措施与改善健康结果相关的证据不一且大多是低确定性的证据，最确定性的证据表明，暂停驱逐与改善COVID-19结果相关。这项研究表明，由于目前的数据仅提供有限的确定性证据，证明预防住房不安全与可衡量的健康收益有关，支付方和政策制定者应考虑将住房不安全干预措施与其他努力结合起来，以改善与改善健康有关的结构性因素。住房不安全——即住房负担能力和稳定性方面的困难——普遍存在，并导致无家可归和健康状况不佳的风险增加。然而，预防无家可归上游的住房不安全的干预措施是否能改善健康仍不确定。回顾住房不安全初级预防策略与成人身体健康、心理健康、健康相关行为、卫生保健使用和卫生保健获取之间关系的证据。独立审稿人对PubMed、Web of Science、EconLit、社会干预研究和评价网络发表了2005年至2021年的定量研究，评估了旨在通过支持风险家庭（有针对性的初级预防）或通过与卫生部门合作加强社区一级住房供应和负担能力（结构性初级预防）直接改善住房负担能力和/或稳定性的干预措施。使用经过验证的工具对偏倚风险进行评估，并使用改进的建议分级评估、发展和评价标准对证据进行综合。共纳入26篇文章，描述3个随机试验和20个观察性研究（16个纵向设计和4个横断面准等候名单对照设计）。现有的干预措施主要侧重于减轻最脆弱个人的住房不安全，而不是彻底预防住房不安全。中等确定性证据表明，暂停驱逐与COVID-19病例和死亡人数减少有关。其他有针对性的初级预防干预措施，包括紧急租金援助、优先等候公共住房的法律援助、长期租金补贴和住房所有权援助，与健康相关的证据的确定性很低或非常低。没有研究评估卫生系统合作的结构性初级预防策略。该系统综述发现，促进住房可负担性和稳定性的干预措施与改善成人健康结果有关，证据不一且大多是低确定性的。现有的干预措施可能需要与其他努力相配合，以解决健康的结构性决定因素。随着卫生保健系统和保险公司对越来越多的机会投资住房作为健康的决定因素作出反应，需要进一步研究，以澄清在住房不安全途径中，干预措施应侧重于最有效和公平的健康影响。本系统综述研究了住房不安全初级预防策略与成人身体健康、心理健康、健康相关行为、卫生保健使用和卫生保健获取之间关系的证据。
Are interventions to prevent housing insecurity by promoting housing affordability and stability associated with improved health outcomes? This systematic review of 26 randomized trials and observational studies found mixed and mostly low-certainty evidence that interventions to prevent housing insecurity were associated with improved health outcomes, with the highest-certainty evidence suggesting that eviction moratoriums were associated with improved COVID-19 outcomes. This study suggests that because current data provide only limited-certainty evidence that preventing housing insecurity is associated with measureable health gains, payers and policy makers should consider pairing housing insecurity interventions with other efforts to improve the structural factors associated with improved health. Housing insecurity—that is, difficulty with housing affordability and stability—is prevalent and results in increased risk for both homelessness and poor health. However, whether interventions that prevent housing insecurity upstream of homelessness improve health remains uncertain. To review evidence characterizing associations of primary prevention strategies for housing insecurity with adult physical health, mental health, health-related behaviors, health care use, and health care access. Pairs of independent reviewers systematically searched PubMed, Web of Science, EconLit, and the Social Interventions Research and Evaluation Network for quantitative studies published from 2005 to 2021 that evaluated interventions intended to directly improve housing affordability and/or stability either by supporting at-risk households (targeted primary prevention) or by enhancing community-level housing supply and affordability in partnership with the health sector (structural primary prevention). Risk of bias was appraised using validated tools, and the evidence was synthesized using modified Grading of Recommendations Assessment, Development, and Evaluation criteria. A total of 26 articles describing 3 randomized trials and 20 observational studies (16 longitudinal designs and 4 cross-sectional quasi–waiting list control designs) were included. Existing interventions have focused primarily on mitigating housing insecurity for the most vulnerable individuals rather than preventing housing insecurity outright. Moderate-certainty evidence was found that eviction moratoriums were associated with reduced COVID-19 cases and deaths. Certainty of evidence was low or very low for health associations of other targeted primary prevention interventions, including emergency rent assistance, legal assistance with waiting list priority for public housing, long-term rent subsidies, and homeownership assistance. No studies evaluated health system–partnered structural primary prevention strategies. This systematic review found mixed and mostly low-certainty evidence that interventions that promote housing affordability and stability were associated with improved adult health outcomes. Existing interventions may need to be paired with other efforts to address the structural determinants of health. As health care systems and insurers respond to increasing opportunities to invest in housing as a determinant of health, further research is needed to clarify where along the housing insecurity pathway interventions should focus for the most effective and equitable health impact. This systematic review examines evidence characterizing associations of primary prevention strategies for housing insecurity with adult physical health, mental health, health-related behaviors, health care use, and health care access.
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