Housing Quality Metric (HQM): Neighborhood-Level Data, Housing Quality, and Population Health

Objectives. To develop a national, tract-level measure of neighborhood housing quality and test its validity by examining associations with population health metrics. Methods. Using microdata from the 2021 American Housing Survey postfit to the 2018-2022 American Community Survey, we developed the Housing Quality Metric (HQM), which predicts the likelihood that a US census tract contains a large share of poor-quality housing units across 3 domains: physical inadequacy, housing cost burden, and poor neighborhood perception. We then used regression models to assess the ecological association between HQM and area-level measures of adult population health (fair or poor general health, poor mental health, and poor physical health) from the PLACES data set. Results. Census tract HQM score was significantly associated with a higher predicted proportion of adults self-reporting all 3 examined negative health status outcomes in both unadjusted and adjusted models. Conclusions. HQM presents the first national, tract-level measure of poor housing quality that has significant associations with adult population health status. Public Health Implications. HQM can be used to target resources and interventions in ways that may better capture the complex relationship between housing quality and population health than existing measures of housing quality. (Am J Public Health. 2025;115(5):780-788. https://doi.org/10.2105/AJPH.2024.307962).