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Housing improvements for health and associated socio-economic outcomes

  1. Hilary Thomson1,*,
  2. Sian Thomas1,
  3. Eva Sellstrom2,
  4. Mark Petticrew3

Editorial Group: Cochrane Public Health Group

Published Online: 28 FEB 2013

Assessed as up-to-date: 13 AUG 2012

DOI: 10.1002/14651858.CD008657.pub2


How to Cite

Thomson H, Thomas S, Sellstrom E, Petticrew M. Housing improvements for health and associated socio-economic outcomes. Cochrane Database of Systematic Reviews 2013, Issue 2. Art. No.: CD008657. DOI: 10.1002/14651858.CD008657.pub2.

Author Information

  1. 1

    Medical Research Council, Social and Public Health Sciences Unit, Glasgow, UK

  2. 2

    Mid Sweden University, Department of Health Sciences, Östersund, Sweden

  3. 3

    London School of Hygiene and Tropical Medicine, Department of Social & Environmental Health Research, Faculty of Public Health & Policy, London, UK

*Hilary Thomson, Social and Public Health Sciences Unit, Medical Research Council, 4 Lilybank Gardens, Glasgow, G12 8RZ, UK. hilary@sphsu.mrc.ac.uk.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 28 FEB 2013

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[Figure 1]
Figure 1. Study flow diagram.
[Figure 2]
Figure 2. Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
[Figure 3]
Figure 3. Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
[Figure 4]
Figure 4. Summary of direction of health impacts from included studies (NB: Arrow size denotes study size not effect size)

* data for children also available;  ** children only;  *** area level data not relating to study population alone, **** adults & children aggregated

Study design: RCT: Randomised Controlled Trial; CBA: Controlled Before & After study; UBA: Uncontrolled Before & After study; XCBA: Cross-sectional controlled Before & After study; XUBA: Uncontrolled cross-sectional Before & After study; RC: Retrospective controlled study (recall of change in health outcomes after intervention); R: Uncontrolled retrospective study. α: more than one intervention group.

Effect direction: upward arrow= positive health impact, downward arrow= negative health impact, sideways arrow= mixed effects/conflicting findings

Sample size: Final sample size (individuals)  in intervention group Large arrow >300; medium arrow 50-300; small arrow <50

Statistical significance: Black arrow p<0.05; grey arrow p>0.05; empty arrow= no statistics/data reported

Statistical tests: Controlled studies- Difference between control and intervention group at follow-up (unless stated); a Difference in change between control and intervention group; b Change within intervention group only; Uncontrolled studies: Change since baseline

Number of outcomes within each category synthesis is 1 unless indicated in subscript beside effect direction

 

Synthesis of multiple outcomes within same outcome category

Where multiple outcomes all report effect in same direction and with same level of statistical significance, report effect direction and indicate overall level of statistical significance

Where direction of effect varies across multiple outcomes:

Report direction of effect and statistical significance where 70% of outcomes report similar direction and similar statistical significance.

If <70% of outcomes report consistent direction of effect report no clear effect/conflicting findings ◄► (size to reflect sample size)

Where statistical significance varies:

If direction of effect similar AND >60% outcomes statistically significant, report as statistically significant (black arrow).

If direction of effect similar AND <60% outcomes statistically significant, report as not statistically significant (grey arrow).
[Figure 5]
Figure 5. Forest plot of comparison: 2 Standardised effect estimates for respiratory outcomes following warmth & energy efficiency improvements (post 1985), outcome: 2.1 Experimental studies.
[Figure 6]
Figure 6. Forest plot of comparison: 5 Standardised effect estimates for general health outcomes following rehousing or retrofitting with or without neighbourhood renewal (post-1995) (non-experimental studies), outcome: 5.1 Poor/fair self-reported health.
[Figure 7]
Figure 7. Forest plot of comparison: 5 Standardised effect estimates for general health outcomes following rehousing or retrofitting with or without neighbourhood renewal (post-1995) (non-experimental studies), outcome: 5.3 Health not improved/worse since one year ago.
[Figure 8]
Figure 8. Logic model mapping impact types and direction, and links to health impacts reported in qualitative and quantitative studies of warmth and energy efficiency improvements.
[Figure 9]
Figure 9. Logic model mapping impact types and direction, and links to health impacts reported in qualitative and quantitative studies of rehousing/retrofitting ± neighbourhood renewal.
[Figure 10]
Figure 10. Logic model mapping impact types and direction, and links to health impacts reported in qualitative and quantitative studies of modern day housing improvements in developed world (warmth and energy efficiency improvements, and rehousing/retrofitting).
[Analysis 1.1]
Analysis 1.1. Comparison 1 Standardized effect estimates for self-reported health following warmth and energy efficiency improvements (post-1985), Outcome 1 Poor/fair self-reported health.
[Analysis 1.2]
Analysis 1.2. Comparison 1 Standardized effect estimates for self-reported health following warmth and energy efficiency improvements (post-1985), Outcome 2 Poor/fair self-reported health (children).
[Analysis 2.1]
Analysis 2.1. Comparison 2 Standardized effect estimates for respiratory outcomes following warmth and energy efficiency improvements (post-1985), Outcome 1 Experimental studies.
[Analysis 2.2]
Analysis 2.2. Comparison 2 Standardized effect estimates for respiratory outcomes following warmth and energy efficiency improvements (post-1985), Outcome 2 Non-experimental studies.
[Analysis 3.1]
Analysis 3.1. Comparison 3 Standardized effect estimates for mental health outcomes following warmth and energy efficiency improvements (post-1985), Outcome 1 Experimental studies.
[Analysis 3.2]
Analysis 3.2. Comparison 3 Standardized effect estimates for mental health outcomes following warmth and energy efficiency improvements (post-1985), Outcome 2 Non-experimental studies.
[Analysis 4.1]
Analysis 4.1. Comparison 4 Standardized effect estimates for illness and symptom outcomes following warmth and energy efficiency improvements (post-1985), Outcome 1 Experimental studies.
[Analysis 4.2]
Analysis 4.2. Comparison 4 Standardized effect estimates for illness and symptom outcomes following warmth and energy efficiency improvements (post-1985), Outcome 2 Non-experimental studies.
[Analysis 5.1]
Analysis 5.1. Comparison 5 Standardized effect estimates for general health outcomes following rehousing or retrofitting with or without neighbourhood renewal (post-1995) (non-experimental studies), Outcome 1 Poor/fair self-reported health.
[Analysis 5.2]
Analysis 5.2. Comparison 5 Standardized effect estimates for general health outcomes following rehousing or retrofitting with or without neighbourhood renewal (post-1995) (non-experimental studies), Outcome 2 Long standing illness.
[Analysis 5.3]
Analysis 5.3. Comparison 5 Standardized effect estimates for general health outcomes following rehousing or retrofitting with or without neighbourhood renewal (post-1995) (non-experimental studies), Outcome 3 Health not improved/worse since one year ago.
[Analysis 5.4]
Analysis 5.4. Comparison 5 Standardized effect estimates for general health outcomes following rehousing or retrofitting with or without neighbourhood renewal (post-1995) (non-experimental studies), Outcome 4 Health interferes with daily activities.
[Analysis 5.5]
Analysis 5.5. Comparison 5 Standardized effect estimates for general health outcomes following rehousing or retrofitting with or without neighbourhood renewal (post-1995) (non-experimental studies), Outcome 5 Lower Physical Component score (SF-36).
[Analysis 5.6]
Analysis 5.6. Comparison 5 Standardized effect estimates for general health outcomes following rehousing or retrofitting with or without neighbourhood renewal (post-1995) (non-experimental studies), Outcome 6 Physical or emotional problems with daily life in past month.
[Analysis 6.1]
Analysis 6.1. Comparison 6 Standardized effect estimates for respiratory health outcomes following rehousing or retrofitting with or without neighbourhood renewal (post-1995) (non-experimental studies), Outcome 1 Wheezing in past year.
[Analysis 6.2]
Analysis 6.2. Comparison 6 Standardized effect estimates for respiratory health outcomes following rehousing or retrofitting with or without neighbourhood renewal (post-1995) (non-experimental studies), Outcome 2 Asthma (children).
[Analysis 6.3]
Analysis 6.3. Comparison 6 Standardized effect estimates for respiratory health outcomes following rehousing or retrofitting with or without neighbourhood renewal (post-1995) (non-experimental studies), Outcome 3 Breathlessness (children).
[Analysis 6.4]
Analysis 6.4. Comparison 6 Standardized effect estimates for respiratory health outcomes following rehousing or retrofitting with or without neighbourhood renewal (post-1995) (non-experimental studies), Outcome 4 Persistent cough (children).
[Analysis 6.5]
Analysis 6.5. Comparison 6 Standardized effect estimates for respiratory health outcomes following rehousing or retrofitting with or without neighbourhood renewal (post-1995) (non-experimental studies), Outcome 5 Bronchitis (children).
[Analysis 6.6]
Analysis 6.6. Comparison 6 Standardized effect estimates for respiratory health outcomes following rehousing or retrofitting with or without neighbourhood renewal (post-1995) (non-experimental studies), Outcome 6 Sinus/Cattarh (children).
[Analysis 7.1]
Analysis 7.1. Comparison 7 Standardized effect estimates for mental health outcomes following rehousing or retrofitting with or without neighbourhood renewal (post-1995) (non-experimental studies), Outcome 1 Lower mental component score (SF-36).
[Analysis 7.2]
Analysis 7.2. Comparison 7 Standardized effect estimates for mental health outcomes following rehousing or retrofitting with or without neighbourhood renewal (post-1995) (non-experimental studies), Outcome 2 Anxiety/depression (self-reported).
[Analysis 8.1]
Analysis 8.1. Comparison 8 Standardized effect estimates for other health related outcomes following rehousing or retrofitting with or without neighbourhood renewal (post-1995) (non-experimental studies), Outcome 1 Smoker.
[Analysis 8.2]
Analysis 8.2. Comparison 8 Standardized effect estimates for other health related outcomes following rehousing or retrofitting with or without neighbourhood renewal (post-1995) (non-experimental studies), Outcome 2 Heavy drinker.
[Analysis 8.3]
Analysis 8.3. Comparison 8 Standardized effect estimates for other health related outcomes following rehousing or retrofitting with or without neighbourhood renewal (post-1995) (non-experimental studies), Outcome 3 < 5 portions of fruit/veg per day.
[Analysis 8.4]
Analysis 8.4. Comparison 8 Standardized effect estimates for other health related outcomes following rehousing or retrofitting with or without neighbourhood renewal (post-1995) (non-experimental studies), Outcome 4 Chronic illness (children).
[Analysis 8.5]
Analysis 8.5. Comparison 8 Standardized effect estimates for other health related outcomes following rehousing or retrofitting with or without neighbourhood renewal (post-1995) (non-experimental studies), Outcome 5 Headaches (children).
[Analysis 8.6]
Analysis 8.6. Comparison 8 Standardized effect estimates for other health related outcomes following rehousing or retrofitting with or without neighbourhood renewal (post-1995) (non-experimental studies), Outcome 6 Indigestion (children).
[Analysis 8.7]
Analysis 8.7. Comparison 8 Standardized effect estimates for other health related outcomes following rehousing or retrofitting with or without neighbourhood renewal (post-1995) (non-experimental studies), Outcome 7 Sleeping problems (children).
[Analysis 8.8]
Analysis 8.8. Comparison 8 Standardized effect estimates for other health related outcomes following rehousing or retrofitting with or without neighbourhood renewal (post-1995) (non-experimental studies), Outcome 8 Eczema (children).
[Analysis 8.9]
Analysis 8.9. Comparison 8 Standardized effect estimates for other health related outcomes following rehousing or retrofitting with or without neighbourhood renewal (post-1995) (non-experimental studies), Outcome 9 Hay fever (children).
[Analysis 8.10]
Analysis 8.10. Comparison 8 Standardized effect estimates for other health related outcomes following rehousing or retrofitting with or without neighbourhood renewal (post-1995) (non-experimental studies), Outcome 10 Pain & discomfort.
[Analysis 8.11]
Analysis 8.11. Comparison 8 Standardized effect estimates for other health related outcomes following rehousing or retrofitting with or without neighbourhood renewal (post-1995) (non-experimental studies), Outcome 11 Limitations to mobility.
[Analysis 9.1]
Analysis 9.1. Comparison 9 Standardized effect estimates for mental health outcomes following rehousing from slums (pre-1975) (non-experimental studies), Outcome 1 Nervousness.
[Analysis 9.2]
Analysis 9.2. Comparison 9 Standardized effect estimates for mental health outcomes following rehousing from slums (pre-1975) (non-experimental studies), Outcome 2 Negative mood.
[Analysis 9.3]
Analysis 9.3. Comparison 9 Standardized effect estimates for mental health outcomes following rehousing from slums (pre-1975) (non-experimental studies), Outcome 3 Dissatisfaction with status quo.
[Analysis 9.4]
Analysis 9.4. Comparison 9 Standardized effect estimates for mental health outcomes following rehousing from slums (pre-1975) (non-experimental studies), Outcome 4 Potency (nothing can be done to improve situation).
[Analysis 9.5]
Analysis 9.5. Comparison 9 Standardized effect estimates for mental health outcomes following rehousing from slums (pre-1975) (non-experimental studies), Outcome 5 Pessimism.
[Analysis 9.6]
Analysis 9.6. Comparison 9 Standardized effect estimates for mental health outcomes following rehousing from slums (pre-1975) (non-experimental studies), Outcome 6 Emotionality (unable to control temper).
[Analysis 10.1]
Analysis 10.1. Comparison 10 Standardized effect estimates for disability following rehousing from slums (pre-1975) (non-experimental studies), Outcome 1 At least one day of disability.