Causal effects of the residential environment on hypertension, heart disease, and asthma: A cross-lagged panel model from a prospective cohort study

Despite the recognition of housing as a determinant of health, most prior studies relied on cross-sectional data, limiting their ability to infer causal effects of residential environments on residents’ health. This study addresses these gaps by conducting a two-wave, 7-year prospective cohort survey, utilizing a cross-lagged panel model, a method also used in public health research, to rigorously analyse causal paths from residential environment quality to health status. Data were collected from 2153 residents on personal attributes, residential environments, and the presence of physician-diagnosed disease among 10 major non-communicable diseases. The analysis identified significant causal effects of residential environment quality on the onset of hypertension, heart disease, and asthma. Odds ratios indicated that better residential environments significantly reduced the likelihood of developing these conditions, particularly hypertension (0.791), heart disease (0.554), and asthma (0.593). Given the high proportion of time people spend indoors, these results underscore the importance of residential design. However, for other diseases where significant causality could not be confirmed in this study, the prevalence samples or the survey intervals may have influenced the results. Addressing these challenges could potentially expand insights, and it is premature to conclude that there is no causal relationship for the remaining diseases. In conclusion, this study expands knowledge in the field of housing and health and highlights the importance of the residential environment in influencing individual health status.