Housing Disadvantage in Childhood and Health: A Systematic Review.

Abstract

Housing is an important determinant of health that is amenable to intervention. Although the negative health effects of living in unaffordable, insecure, and unsuitable housing have been well established for adults, little is known about the causal effect of housing disadvantage in childhood and health across the life course. This review aims to synthesize evidence from longitudinal studies on housing disadvantage in childhood and health. Longitudinal studies (2000-2025) were systematically reviewed to examine the impact of insecure, unaffordable, or poor-quality housing experienced during childhood (aged 0-18 years) on subsequent physical, mental, or behavioral health outcomes. Risk of bias was assessed with ROBINS-E, and evidence was graded using causal criteria including study design, temporality, confounder control, and measurement validity. A total of 63 studies were included, spanning 16 countries and follow-up periods ranging from 1 to 68 years. Registry and quasi-experimental studies provided the strongest evidence, showing that insecure housing was associated with later mental illness, substance misuse, and premature mortality. Poor-quality housing was linked to respiratory outcomes and general health, with suggestive causal signals in studies with extended follow-up and robust adjustment. Evidence for effects of overcrowding and housing affordability was inconsistent, limited by measurement error and confounding. Living in disadvantaged housing in childhood may impact health later in life. Although some studies offer suggestive causal signals, many lacked formal life-course modeling or designs that enable causal inference. Greater methodological integration and longitudinal investment will be critical to clarify pathways and inform policy responses.