From home to hospital: An integrated evaluation of public housing and children's health in San Francisco, CA

Housing is an important social determinant of health, and may play an especially important role in children’s health. We evaluated how different types of housing affects children’s emergency health care utilization patterns and health outcomes. We created an integrated database of public housing and hospital visits to three large medical centers in San Francisco, CA by geocoding and joining public housing locations (N=3,477) with residential addresses of all children 0 to 18 years old seeking care from 2007-2011 (N=47,213). Patients were coded in terms of whether they lived in public housing (n=3,246) and if the public housing was part of the HOPE VI Program (n=551). We limited analyses to children residing within the same census tracts as public housing (n=9,283) and adjusted for insurance status and other potentially confounding individual-, hospital-, and neighborhood-level characteristics. Children living in non-redeveloped, traditional public housing were 38 percent more likely to have one or more repeat visits to an emergency or urgent care department within one year compared to children not living in public housing (OR 1.38 [1.20-1.58]; p<0.001). In contrast, children living in HOPE VI public housing did not have significantly greater risk for repeat hospital visits compared to children not living in public housing (OR 1.20 [0.97-1.50], p=0.09). Children who lived in public housing were more likely to have a diagnosis for a non-complex chronic condition (18% vs. 12%), skin or dermatologic disease (22% vs. 12%), or disease of the ear, nose, throat, or mouth (39% vs. 32%). These findings suggest that living in public housing may be a risk factor for particular pediatric health outcomes. Policies promoting public housing redevelopment and affordable family housing outside of traditional public housing projects may improve child health and reduce healthcare costs.