Housing and health outcomes of public housing applicants and residents: a population-based study
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Public housing, a form of low income housing, is owned and managed by government. The goal of this research was to use linked population-based administrative databases to examine the associations among public housing and sociodemographic characteristics, health, healthcare use, and residential mobility. Four related studies were undertaken. The first study determined the factors associated with applying to public housing. A cohort who applied in 2005 and 2006 was matched to a general population cohort. Individuals who applied tended to be in poorer health and were more frequent healthcare users compared to individuals with similar socioeconomic characteristics from the general population. The second study tested the factors associated with moving out of public housing, while accounting for tenancy length. A cohort who moved in 2007 and 2008 was followed for seven years. Three groups were identified; voluntary movers, evicted movers, and non-movers. Socioeconomic characteristics of the cohort were associated with moving out voluntarily. Health and healthcare use were associated with eviction. The third study describes healthcare use patterns in a cohort who moved into public housing in 2009 and 2010. Healthcare use was measured before and after the move-in date and the difference was tested. In general, there was an increase in use approximately three months before the move-in date and a decrease three months after. After this, use returned to pre-move-in levels. The fourth study tested whether changes in healthcare use are unique to public housing residents. A cohort who moved into public housing in 2012 and 2013 was matched to a general population cohort and a move-in date was randomly assigned. Different types of healthcare use were measured before and after the move-in date. The public housing cohort used healthcare services more frequently. For most healthcare measures, changes in use were similar between the two cohorts. This research demonstrates that public housing is used by low income individuals who often have health conditions. This form of housing may represent a social safety net for users. Public housing can be used to deliver programs to improve health and wellness and address issues of housing instability.