OP15 Housing disadvantage in childhood and health: a systematic review

Background Housing has been recognised as one of the most important determinants of health. While there is evidence that housing disadvantage can influence social and behavioural outcomes for children, little is known of the contribution of these pathways to children’s health and wellbeing. This review aims to provide a synthesis of evidence from longitudinal cohort and interventional studies linking experiences of disadvantaged housing in childhood to health outcomes Methods A literature search was performed on four databases including Medline (Ovid), EMBASE (Ovid), PsycINFO (Ovid), and Web of Science from 2000 to 2020. Peer-reviewed longitudinal studies assessing the association between housing disadvantage (physical quality, affordability, and instability) in childhood and subsequent physical and mental health were included. The methodological quality of selected studies was appraised using the ROBINS-I (Risk Of Bias In Non-randomised Studies - of Interventions) tool. A narrative synthesis was developed due to study heterogeneity. Results Forty-five cohort studies met the inclusion criteria. The majority of the studies was evaluated to have a moderate risk of bias. The most studied housing exposure was residential mobility, followed by overcrowding and housing tenure. Other exposures examined in the set of eligible studies include housing facilities (e.g., ventilation, toilet), inadequate heating and self-rated housing condition. Most studies assessed multiple health outcomes, including mortality, respiratory health, substance misuse, subjective measures of health, diagnosed mental disorders, cardiovascular diseases risk factors, and healthcare utilisation. Across the studies, while many relationships remained mixed, consistent evidence of detrimental impact was identified between: poor housing conditions and mortality and self-rated health; inadequate heating and respiratory illness; poor ventilation and all-cause mortality; frequent residential moves and psychiatric mortality and morbidity. Little evidence is found between overcrowding in childhood and health outcomes. Conclusion Evidence from longitudinal studies indicates that poor housing experience in childhood may impact health later in life. The findings confirm that housing as a key social determinant of child health, and interventions designed to mitigate housing disadvantage may have significant health gains across the life span.