THE LIVING CONDITIONS IN DWELLINGS FROM

DIFFERENT DISTRICTS OF IASI AND THE

LODGERS HEALTH STATUS:

A CASE – CONTROL EPIDEMIOLOGICAL STUDY

Oana Drug, Marieta Vasilov

Institute of Public Health Iasi, Romania

On the basis of theoretical knowledge, in the lack of some systematic studies regarding habitat conditions and their relationship with lodgers status health, especially for Iasi city, we considered this study, regarding the dwelling as stress or protective factor, being opportune. The hypothesis of this study (which starts from the effect and investigates the risk factors presence in the subjects’ past) was that these risk factors are more frequent in sick people than in healthy people.

The objectives of this case-control study are:to evaluate the living conditions in dwellings from different districts of Iasi city;to relieve some health aspects of population with different habitat conditions;to evaluate the implication (or contribution) of some living conditions in some illnesses or discomfort aspects;to elaborate recommendations for a risks limitation program.

MATERIAL AND METHOD This case – control epidemiological study checked up the relationship between some risk factors from dwellings and some physic or mental disorders. Two groups were constituted for this study (a control group and a case group) based on the following criteria: the cases group constituted by persons diagnosed with depression, neurosis, anxiety, or associations of this affections; the control group constituted by apparently healthy persons with the same structure (age, sex, occupation etc.) in statistic ratio 1:1, from the same districts and type of dwellings as the study group. The collected data for the study taken into consideration are: The risk factors in dwellings, which were known both, through lodgers interview and physics determinations: over-crow, microclimate, illumination, sources of noise, warm and cold water supply. The physic status health of lodgers was known through positive and negative indicators and the mental status health was known through psychological tests: Eysenck test for neurosis, Cattel test for anxiety and Beck-Philadelphia test for depression. Those are symptoms or prediction elements for psychic diseases which should be in relationship with habitat conditions. The medical and social questionnaire, used like auxiliary tool, pointed out some discomfort symptoms produced by living conditions and was elaborated and validated (pilot study) by our Institute. For the epidemiological processing we used frequency and distribution indicators, statistical significance for different risk factors in dwellings; the epidemiological interpretation is checked up through analytical techniques (OR, AR%).

RESULTS AND DISCUSSION

The cases and control groups are presented in Tab. 1 and consist of 83 cases simple or in association of anxiety, neurosis, depression and a control group of 93 subjects, with dominated age between 31 – 45 years and women having active age, similar with control group.

Age (years) / samples

Case group

Control group

18 – 30 18 44

31 – 45 43 46

46 – 60 15 2

> 60 7 1

Total 83 93

From which: Male

24 42

Female

69 51

Tab. 1 The structure of the groups on age and sex for the case – control study

Tab. 2 Structure on age, sex and mental disorders for the case sample

a) Anxiety b) Depression

Age / Sex

M F M+ F M F M +F

18 – 30 2 7 9 - - -

31 – 45 - 8 8 1 - 1

46 – 60 - 2 2 - - -

> 60 - - - - - -

Total 2 17 19 1 - 1

c) Depression + Anxiety

d) Anxiety +Neurosis

Age / Sex M F M + F M F M+ F

18 – 30 - 1 1 1 1 2

31 – 45 1 2 3 5 1 6

46 – 60 1 - 1 - - -

> 60 - - - - - -

Total 2 3 5 6 2 8

e)Depression + anxiety + neurosis

f) Control group

Age / sex

M F M + F

M F M+ F

18 – 30 - 6 6 16 28 44

31 – 45 7 18 25 23 23 46

46 – 60 4 8 12 2 - 2

> 60 2 5 7 1 - 1

Total 13 37 50 42 51 93

Detailing the types of health damage, the cases group is dominated by treble association between depression, anxiety, and neurosis.

This distribution suggested that these psychic disorders are more frequent in women having active ages.

Table 3 detailed the health affection aspects on age and risk factors presence. For over 46 years of age, the small number of subjects did not allow any epidemiological analysis.

18 – 30 yearsRisk factors

+ -

Total

Anxiety 5 4 9

Depression+ Anxiety - 1 1

Anxiety+ Neurosis 2 - 2

Anxiety+ Depression+ Neurosis

5 1 6

Total cases 12 6 18

Control sample 12 32 44Test 2Yates= 7.15; OR = 5.3; AR%= 81.1%

31 – 45 years Risk factors+ -

Total

Anxiety 4 4 8

Neurosis 1 - 1

Depression + Anxiety

2 1 3

Anxiety + Neurosis 5 1 6

Anxiety+ Depression + Neurosis

15 10 25

Total cases 27 16 43

Control sample 18 28 46Test 2Yates = 40.07; OR= 2.6; AR%= 61.5%

46 – 60 years Risk factors+

-

Total

Anxiety - 2 2

Depression + Anxiety 1 - 1

Anxiety + Depression + Neurosis

8 4 12

Total cases 9 6 15

Control sample 1 1 2> 60 years Risk factors

+ -

Total

Anxiety+ Depression + Neurosis

4 3 7

Control sample 1 - 1

Tab. 3 Mental health disorders on age and present risk factors

For the whole study group in comparison with control group, the risk factors contribution is about 69%. From the questionnaire it resulted that the risk factors are present in 52 persons in case group (62.6%) and 32 persons in control group (34,4%); the difference is strongly statistically significant (2

Y test = 12,9; FD = 1; p<0,001).

Risk factors+ -

Total

Anxiety 9 10 19

Neurosis 1 - 1

Depression + Anxiety 3 2 5

Anxiety + Neurosis 7 1 8

Anxiety + Depression + Neurosis

32 18 50

Total cases 52 31 83

Control sample 32 61 93Test 2Yate= = 12.9; OR # 3.19; AR% = 68.6%

Tab. 4 Comparative data of case and control samples depending on the presence of risk factors

62,6%

34,4%

010203040506070

case control Sample

Y = 12.9

Fig. 1 The presence of risk factors in three case subgroups in comparison with control

group and differences between samples

OR = 1.90 OR= 3.39 AR% = 47.4% AR% = 70.5%

CONFIRM THE HYPOTESIS

a) with a single type of health

affection

b) with double association

c) with treble association

OR =2.77AR% = 64%

For a more detailed analysis we divided the case group into three different subtypes:• with a single type of health affection;• with an association of two types of affection;• with the association of all three forms:anxiety+depression+neurosisRegarding the risk factors frequency in the subjects’ past, each subtype was compared to control group. Only in the case of the association of 2 – 3 forms of health affections the difference to control group is statistically significant and the contribution of risk factors concerning the treble association is higher in comparison with double association.

10

20

32

93

10

13 32

93

32

50

32

93

0

10

20

30

40

50

60

70

80

90

100

casecontrol

case Samples

Samples

from whichwith riskfactors

Y

9

Y .4

2y= 1.11 2

y= 6.9 2y= 10.4

controlcase

control

CONCLUSIONS

The study hypothesis was confirmed by suitable values of analytical techniques: OR = 2.77 and AR% = 64%.The study results were the support of a programme of measures mainly with primary preventive recommendations.These recommendations are meant for: local authorities – Mayoralty, City Water Supply Services, City Salubrity Services – for the assurance of city sanitation through salubrious wastes evacuation, of continuously distribution of drinking water in all districts of the city and of chemical, biological and bacteriological quality of drinking water; lodgers’ associations – for draining, sanitation of basements and neighbourhoods; population – instructive and social measures in order to know, recognise and avoid the risks generated by living conditions which enclose to other risk factors from the environment and lifestyle; for this reason a sanitary education material was elaborated.