Development of a multidimensional housing and environmental quality index (HEQI): application to the American Housing Survey

Our plain-English summary of Development of a multidimensional housing and environmental quality index (HEQI): application to the American Housing Survey, by M.T. Chu, A. Fenelon, J. Rodriguez, et al (Environmental Health, 2022).

The study

• Authors: M.T. Chu, A. Fenelon, J. Rodriguez, A.R. Zota, G. Adamkiewicz
• Journal: Environmental Health
• Published: 2022;21(1):56
• Cited by: 11 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Substandard housing conditions and hazardous indoor environmental exposures contribute to significant morbidity and mortality worldwide. Housing indices that capture the multiple dimensions of healthy housing are important for tracking conditions and identifying vulnerable households. However, most indices focus on physical deficiencies and repair costs and omit indoor environmental exposures, as few national data sources routinely collect this information.

Methods: We developed a multidimensional Housing and Environmental Quality Index (HEQI) based on the World Health Organization's Housing and Health Guidelines and applied it to the 2019 American Housing Survey (AHS). The HEQI consisted of ten domains associated with poor health: household fuel combustion, dampness and mold, pests and allergens, lead paint risk, high indoor temperatures, low indoor temperatures, household crowding, injury hazards, inadequate water and sanitation, and ventilation. We evaluated the validity and performance of the HEQI against three housing characteristics (i.e., year built, monthly rent costs, unit satisfaction rating) and two established indices (i.e., Adequacy Index, Poor Quality Index).

Results: Approximately 79% (92 million) of U.S. households reported at least one HEQI domain associated with poor health (mean per household: 1.3; range: 0,8). Prevalent domains included household fuel combustion (61.4%), dampness and mold (15.9%), inadequate water and sanitation (14.3%), and injury hazards (11.9%). Pests and allergens, low indoor temperatures, and injury hazards were consistently associated with older homes, lower rent costs, and lower unit satisfaction. Compared to established housing indices, the HEQI captured four new environmental domains which enabled the identification of 57.7 million (63%) more households with environmental risk factors like mold, cockroaches, crowding, household fuel combustion, and higher building leakage.

Conclusions: Indoor environmental exposures are prevalent in U.S. households and not well-captured by existing housing indices. The HEQI is a multidimensional tool that can be used to monitor indoor environmental exposures and housing quality trends in the U.S. Some domains, including radon, pesticides, asbestos, noise, and housing accessibility could not be assessed due to the lack of available data in the AHS. The mounting evidence linking residential environmental exposures with adverse health outcomes underscore the need for this data in the AHS and other national surveys.

© 2022. The Author(s).

In plain English

Asbestos was not studied here; it appears only as a hazard the authors could not measure. The authors built a Housing and Environmental Quality Index (HEQI) of ten health-related housing domains based on World Health Organization guidelines and applied it to the 2019 American Housing Survey. After excluding vacant and mobile homes, 51,933 occupied units were analyzed (tables print 51,993), weighted to represent U.S. households. About 78.5% (92.0 million) of U.S. households reported at least one domain. Household fuel combustion (61.4%) and dampness and mold (15.9%) were common, while lead paint risk (1.7%) was among the least common. The HEQI flagged at least 57.7 million more households with hazards than two existing indices. Asbestos, radon, pesticides, noise and housing accessibility could not be assessed for lack of data across survey years; the survey had no asbestos questions, and radon and accessibility questions only in some subsamples or years. The authors concluded that indoor environmental exposures are prevalent in U.S. households and not well captured by existing indices. They noted answers were self-reported and some domains only roughly approximated.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Development of a housing index, applied to and tested against existing national household survey data (2019 American Housing Survey)
• Who was studied: Occupied housing units in the 2019 U.S. American Housing Survey national public file. The survey had 63,185 households. After excluding vacant units, units whose owner usually lived elsewhere, and mobile housing types, the Methods give a final sample of 51,933 occupied housing units; the table headings print 51,993. The sample was weighted to represent U.S. households.
• Exposure: Ten housing and indoor environmental domains: household fuel combustion, dampness and mold, pests and allergens, lead paint risk, high indoor temperatures, low indoor temperatures, household crowding, injury hazards, inadequate water and sanitation, and ventilation. Asbestos was not assessed.
• Main results:
  • About 78.5% (92.0 million) of U.S. households reported at least one HEQI domain.
  • About 72 million (61.4%) of U.S. households reported at least one household fuel combustion source.
  • About 18.7 million (15.9%) of households reported mold and damp environments.
  • Lead paint risk (1.7% of households) was among the least prevalent domains.
  • Compared with the Poor Quality Index and the Adequacy Index, the HEQI identified at least 57.7 million more U.S. households with one or more residential health hazards.
  • Among renter households, high building leakage was associated with lower monthly rent (adjusted relative ratio 0.77, 95% CI 0.73 to 0.80), and severe crowding with higher rent (aRR 1.26, 95% CI 1.13 to 1.42).
  • Asbestos, together with radon, pesticides, noise and housing accessibility, could not be captured because the survey lacked data across survey years.
  • Asbestos was rated 'Unavailable', meaning the national surveys of 2011 to 2019 asked no relevant questions; radon questions were asked only in subsamples, and accessibility questions only in specific years and subsamples.
  • Radon questions were asked in survey subsamples only.
• The authors' conclusion: The authors concluded that indoor environmental exposures are prevalent in U.S. households and not well captured by existing housing indices.
• Limitations the authors state:
  • Survey items were self-reported and may be affected by recall error or social desirability bias.
  • The survey may underestimate households in precarious or temporary housing.
  • The survey was conducted mostly in English and Spanish, so findings may not generalize to households speaking other languages.
  • Six domains (household fuel combustion, lead paint risk, pests and allergens, high indoor temperatures, injury hazards, ventilation) were only approximated and likely imprecise.
  • The lead paint risk estimate is likely conservative.

Topics

Medical terms in this study, explained in our Lexicon: Environmental Exposure.

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