Housing status and disparities of healthy life expectancy: JAGES cohort project
METHODS: A population-based self-administered mail survey was conducted for independent people without long-term care need aged 65 and over in 6 municipalities of Japan in 2003. Death and incidence of care need were followed up until 2010. Cox's proportional hazard model was applied to estimate hazard ratios of home renters compared with home owners adjusting for sex, age, and equivalised household income. Life expectancy (LE) and HLE without care need for people who own and rent their homes were estimated using the Sullivan method and the Japanese national life table in 2010.
RESULTS: We followed up 13,176 participants for 6.7 years on average. Hazard ratios (95% confidence interval, p) of home renters for death was 1.296 (1.100-1.528, 0.002), while that for incidence of care need was 1.288 (1.059-1.566, 0.011). HLEs of males were 78.9 years for home owners and 76.3 years for home renters, against 83.7 years for female home owners and 81.1 years for female home renters. Further analyses revealed that home renters have more barriers inside and at access to their homes and experienced more falls compared with home owners. Home owners live longer in the same regions and show more trust for people and the norm of reciprocity. Among home renters, public housing renters had better mental health status than private housing renters based on our other cross-sectional data in 2010.
CONCLUSIONS: There were 2.6 years of HLE disparities by housing status. Housing status is thought to be one of the important social determinants of health. Age-friendly rental housing should be provided by collaboration of the health and housing sectors and promoting good public housing policy.