OP08 Impacts of housing insecurity and cuts to housing support services on health in the UK: a longitudinal controlled study

Background

Housing insecurity in the UK is increasing, fuelled by rising unaffordability, lack of supply, benefit cuts, and insufficient tenant protections. An important form of housing insecurity is the threat of eviction, which often follows a period of being in rent or mortgage arrears. Eviction rates rose in England between 2010 and 2015, coinciding with cuts to housing benefit and a decline in public spending on housing support services. Our study assesses the health impacts of housing insecurity and potential moderating role of local authority (LA) investment in housing over the past decade.

Methods

In this longitudinal study (2009–2018), we used individual-level data from the UK Household Longitudinal Study linked to annual local authority data on housing services. Health outcomes included measures of mental health (from GHQ and SF-12); sleep disturbance due to worry; and incident hypertension. Housing insecurity exposures were (a) falling behind in housing payments, and (b) experiencing an involuntary move due to eviction, damp/unhealthy housing, or employer relocation. To assess effect modification, we classified LAs as having substantially cut spending or not (2016 spending ≥25% reduced from 2009 levels, or ≥50% reduction in a sensitivity analysis). We used confounder-adjusted fixed-effects panel regression models to estimate within-person change in each outcome following housing payment problems or involuntary moves. We added an interaction term with LA spending cuts to assess effect modification. We then specified marginal structural models (MSMs) with inverse probability of treatment weights (IPTWs) to check the robustness of our findings to an alternative modelling approach.

Results

23% of the sample experienced housing payment problems; 3% experienced involuntary mobility. In fixed-effects models, housing payment problems were associated with increased odds of a probable common mental disorder (OR=1.22, 95%CI 1.08–1.39) and sleep disturbance (OR=1.29; 95%CI 1.14–1.45), and MSM results were similar. While involuntary moves were associated with most outcomes in the fixed-effects models, but due to unbalanced IPTWs the effects of involuntary moves were not estimated with MSMs, and our fixed-effects models for moves may be biased. Living in a LA that substantially cut spending on housing services does not appear to be a strong modifier of the associations.

Conclusion

Housing payment problems were associated with worse mental health and sleep disturbance in a large UK sample, during a period of austerity with reduced spending on housing support services. The low prevalence of involuntary moves is a limitation of the study.