Precarious housing and health inequalities in Spain since the crisis

BACKGROUND: Housing is considered crucial to human existence and has been recognized as a key social determinant of health. However, the “housing question” has become a major issue in high-income countries. In this context, the concept of precarious housing has emerged to describe the increasing prevalence of insecure and unstable housing conditions. However, its research has been limited to very specific national and temporal contexts. To address this gap, the present paper aims to study the predictors of precarious housing and its impact on health inequalities in the Spanish context since the GFC. METHODS: The methodology will consist of a multilevel analysis of pooled cross-sectional data from the Spanish Survey of Living Conditions (ECV) 2007-2020 (N = 51882) to identify the predictors of housing precariousness. Then, we are going to examine the associations between precarious housing and health outcomes and inequalities through multivariate logistic regressions. RESULTS: Our descriptive results show that precarious housing has become a persistent problem in the Spanish context. Furthermore, we found that precarious housing levels are unevenly distributed across the population along axes of inequality. In this respect, tenure status emerges as a critical predictor. Compared to outright homeowners, mortgage homeowners, market rental tenants, social rental tenants, and free cession dwellers experience significantly higher levels of housing precariousness (RR: 6.53, CI: 5.97 - 7.15; RR:8.10, CI:7.37-8.91; RR:5.72, CI:5.06-6.48; and RR:1.41, CI:1.21-1.65 respectively). Finally, we show that precarious housing conditions are significant predictors of health outcomes and inequalities. The odds ratio (OR) of reporting lower self-reported health increases with the number of precarious housing levels: 1.68 (CI: 1.52-1.85) for one level, 2.43 (CI: 1.94-3.03) for two levels, and 3.55 (CI: 2.23-5.67) for three levels. KEY MESSAGES: • Precarious housing is influenced by axes of inequality such as age, gender or nationality. • Health inequalities are strongly associated with precarious housing conditions.