Renovated public housing tied to fewer repeat ER visits for kids

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[December 16, 2014]  By Ronnie Cohen

(Reuters Health) - Kids living in renovated public housing were less likely to repeatedly need emergency medical care than kids living in run-down public housing, a new study found.

“The study really shows a direct link between kids’ health, the use of emergency rooms and the type of housing they’re in,” said Nancy Adler, the senior researcher on the study.

“Investments in better quality public housing may help kids be healthier and also may be good for the economic bottom line,” said Adler, professor of psychiatry and pediatrics at the University of California, San Francisco, School of Medicine. “It could save society money on healthcare costs.”

Adler and her colleagues examined data on the emergency and urgent-care needs of 5,711 children in San Francisco with public insurance living in either private housing, renovated public housing or old public housing.

Over the past 20 years, the federal Housing Opportunities for People Everywhere, or HOPE VI, program redeveloped 56,800 public housing units, the researchers write in the journal Health Affairs.

HOPE VI aimed to transform not only the physical environment of developments once known as projects, but also to create mixed-income neighborhoods with lower-density housing and a range of social services, such as child care.

At first look, children living in the old public housing were more likely to visit the hospital than those living in private housing.

There was no difference between children living in renovated public housing and children living in either old public housing or private housing, however.

But the researchers did find a difference for repeat emergency hospital visits. With raw data, the rates were 48 percent for the 3,266 children in private housing, 51 percent for the 368 children in renovated housing, and 52 percent for the 2,077 children in older public housing.

But after adjusting the data for the children’s demographics, health, neighborhood and the hospital where they received treatment, they found that children living in old public housing were about 37 percent more likely to have repeat hospital visits than children in private housing.

Children living in the old public housing were also 39 percent more likely to have a repeat emergency hospital visit, compared to those in the refurbished public housing.

The researchers can’t say why redeveloped public housing led to fewer repeat emergency hospital visits, but Adler said it could be due to a combination of benefits – better access to food, fewer injury-causing hazards and fewer environmental dangers, such as less lead-based paint, mold and other allergens.

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In addition, families in renovated public housing may be under less stress, she said.

Residents of public housing units that have not been renovated have complained about crime, cockroaches, mice, mold and broken elevators.

The researchers are now analyzing the diagnoses given to the children at the hospitals to see if they can find out what led to the need for care, Adler said.

“There is a clear need to better understand the range of social and economic factors that lead to these high visit rates, and understand the link between housing and health,” she said.

Danya Keene, a professor at the Yale School of Public Health, called the 39 percent reduction in emergency visits “huge.”

“It’s great that these kids are benefiting from this high-quality affordable housing,” she told Reuters Health.

“The paper does support the idea that living conditions matter for health in significant ways,” Keene said. “We can save healthcare dollars by improving people’s living conditions.”

She cautioned against reading the results as an indictment of old public housing, however.

“Even though the conditions in many public housing developments are in dramatic need of improvement, we do know that public housing provides an important source of stable and affordable housing, particularly for the poorest of the poor,” Keene said.

SOURCE: http://bit.ly/1zbVi4s Health Affairs, online December 8, 2014.

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