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


CONCLUSIONS
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.
Singapore General Hospital, Singapore; Family Medicine, Duke-NUS Medical School, Singapore.
Lian Leng
LL
Low
Saw Swee Hock School of Public Health, National University of Singapore , Singapore.
Win
W
Wah
Singapore General Hospital, Singapore; Family Medicine, Duke-NUS Medical School, Singapore.
Matthew Joo
MJ
Ng
Singapore General Hospital, Singapore; Family Medicine, Duke-NUS Medical School, Singapore.
Shu Yun
SY
Tan
Singapore General Hospital, Singapore; Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore.
Nan
N
Liu
Singapore General Hospital, Singapore; Family Medicine, Duke-NUS Medical School, Singapore.
Kheng Hock
KH
Lee
hospital utilization; housing; readmission; social determinant of health