{
  "abstract": "Objectives Inadequate housing and living conditions underpin significant health and wellbeing inequality in Australia, particularly for Indigenous people. This review aimed to define infectious disease (ID) outcomes used to measure the health impact of inadequate housing in Australia within a research context.Design A systematic review of published studies following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines.Data sources Four online databases were searched in May 2024 with no date restrictions using terms relating to housing, ID and Australia. Results were screened in Covidence.Eligibility criteria Studies were included if they measured both housing exposures and ID outcome variables among any population group in Australia. Both quantitative and qualitative designs were considered.Data extraction and synthesis Data were extracted from 81 studies. Exposures and outcomes were classified according to the Healthy Living Practices (HLPs) and the International Classification of Primary Care (ICPC-2) body system classes, respectively. Acute infections and chronic post-infectious sequelae were considered ID outcomes. Descriptive statistics were calculated and ID-HLP associations were synthesised and narratively described. Methodological quality was assessed from both biomedical and Indigenous perspectives using relevant appraisal tools.Results Most studies (79%) were published within the past 25 years and more than half (60%) involved remote-living Indigenous children and families. A total of 176 measured ID outcomes and 571 ID-HLP associations were tested. Exposures were frequently related to the negative effects of crowding (HLP5), unsafe wastewater treatment/drinking water (HLP3) and reduced capacity for washing people (HLP1). Skin, respiratory and digestive system infections were the most common ID outcomes, followed by eye and ear infections and post-infectious cardiovascular sequelae. Studies relied on intensive data collection methods and bespoke definitions.Conclusions Substantial research has described ID outcomes associated with inadequate housing in Australia. However, high-quality evidence is lacking, and methodological heterogeneity between studies limits the synthesis and actionability of this work. We recommend prospective classification of housing exposures according to the HLPs and encourage the exploration of routinely collected primary care data. Agreed measurement approaches and data collection tools that are consistent with Indigenous Data Sovereignty principles would add value.PROSPERO registration number CRD42024541393.",
  "authors": [
    {
      "affiliations": [
        "Wesfarmers Centre for Vaccines and Infectious Diseases, The Kids Research Institute Australia, Nedlands, Western Australia, Australia"
      ],
      "name": "Kate Summer"
    },
    {
      "affiliations": [
        "Wesfarmers Centre for Vaccines and Infectious Diseases, The Kids Research Institute Australia, Nedlands, Western Australia, Australia"
      ],
      "name": "Keerthi Anpalagan"
    },
    {
      "affiliations": [
        "Department of Infectious Diseases, Perth Children’s Hospital, Nedlands, Western Australia, Australia",
        "Cardiovascular Epidemiology Research Centre, The University of Western Australia, Nedlands, Western Australia, Australia"
      ],
      "name": "Ingrid Stacey"
    },
    {
      "affiliations": [
        "Department of Infectious Diseases, Perth Children’s Hospital, Nedlands, Western Australia, Australia"
      ],
      "name": "Samantha Stiles"
    },
    {
      "affiliations": [
        "Wesfarmers Centre for Vaccines and Infectious Diseases, The Kids Research Institute Australia, Nedlands, Western Australia, Australia"
      ],
      "name": "Rachel Burgess"
    },
    {
      "affiliations": [
        "Cardiology Population Health Laboratory, Victor Chang Cardiac Research Institute, Darlinghurst, New South Wales, Australia"
      ],
      "name": "Vicki Wade"
    },
    {
      "affiliations": [
        "Wesfarmers Centre for Vaccines and Infectious Diseases, The Kids Research Institute Australia, Nedlands, Western Australia, Australia",
        "Menzies School of Health Research, Darwin, Northern Territory, Australia"
      ],
      "name": "Asha C. Bowen"
    },
    {
      "affiliations": [
        "Department of Infectious Diseases, Perth Children’s Hospital, Nedlands, Western Australia, Australia"
      ],
      "name": "Judith Katzenellenbogen"
    },
    {
      "affiliations": [
        "Wesfarmers Centre for Vaccines and Infectious Diseases, The Kids Research Institute Australia, Nedlands, Western Australia, Australia",
        "Yardhura Walani, Australian National University, Canberra, Australian Capital Territory, Australia"
      ],
      "name": "Rosemary Wyber"
    }
  ],
  "title": "Infectious disease outcomes associated with inadequate housing and access to healthy living practices in Australia: a systematic review",
  "uid": "e5f7e1d8-c85f-52e7-8441-9d6e47fcbd5e"
}