Housing as a Social Determinant of Health in Singapore and Its Association with Readmission Risk and Increased Utilization of Hospital Services

Lian Leng Low · Win Wah · Matthew Joo Ming Ng · Shu Yun Tan · Nan Liu · Kheng Hock Lee

63 citations0/0 files storedFrontiers in Public Health

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Health disparities and outcomes Homelessness and Social Issues Public Health and Social Inequalities

Abstract

BACKGROUND: Residence in public rental housing is an area-level measure of socioeconomic status, but its impact as a social determinant of health in Singapore has not been studied. We therefore aimed to examine the association of public rental housing with readmission risk and increased utilization of hospital services in Singapore. METHODS: We conducted a retrospective cohort study using retrospective 2014 data from Singapore General Hospital's electronic health records. Variables known to affect readmission risk and health-care utilization were identified a priori and include patient demographics, comorbidities, health-care utilization in the preceding 1 year and clinical variables from the index admission in 2014. Multivariate logistic regression was used to evaluate public rental housing as an independent risk factor for admission risk, emergency department (ED), and specialist outpatient clinic attendances. RESULTS: A total of 14,457 unique patients were analyzed, and 2,163 patients (15.0%) were rental housing residents. Rental housing patients were significantly more likely to be male; required financial assistance; have chronic obstructive pulmonary disease; usage of anti-depressant and anti-psychotic medications; longer length of hospital stay during the index admission; and higher Charlson Comorbidity Index scores. After adjusting for demographics and clinical variables, staying in public rental housing remained an independent risk factor for readmission within 15 and 30 days, frequent hospital admissions and ED attendances in Singapore. CONCLUSION: Our study showed an association between public rental housing with readmission risk and increased utilization of hospital services in Singapore. A deeper understanding of the residents' social circumstances and health seeking behavior would be insightful.

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2005Indicators of socioeconomic position (part 1): Figure 1 2003Social determinants of health: the solid facts 2002Housing and Health: Time Again for Public Health Action 2014Neighborhood Socioeconomic Disadvantage and 30-Day Rehospitalization 2015Patient Characteristics and Differences in Hospital Readmission Rates 2014Socioeconomic Status And Readmissions: Evidence From An Urban Teaching Hospital 2014Is socioeconomic status associated with utilization of health care services in a single-payer universal health care system?2013Income inequality and 30 day outcomes after acute myocardial infarction, heart failure, and pneumonia: retrospective cohort study

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2021Data, Social Determinants, and Better Decision-making for Health: the 3-D Commission 2018Public rental housing and its association with mortality – a retrospective, cohort study

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