Can housing improvements cure or prevent the onset of health conditions over time in deprived areas?

Curl, Angela; Kearns, Ade

doi:10.1186/s12889-015-2524-5

Cited by 23 publications

(34 citation statements)

References 33 publications

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“… 27 An analysis of the pathway between housing improvements and health conditions in Glasgow, Scotland concluded that although energy efficiency measures could help manage symptoms, they did not prevent the occurrence of disease. 28 In addition, another study cautioned that evaluation of energy efficiency measures provided only a snapshot of historical exposure and that improvements could not mitigate health impacts of cold and damp related exposures built up over a lifetime. 8 However, as hospital admission rates increased with increasing levels of deprivation leading to greater absolute reductions in hospital admissions in the highest deprivation fifths, targeting more deprived communities could still provide an overall greater impact on health than untargeted interventions.…”

Section: Discussionmentioning

confidence: 99%

Association between home insulation and hospital admission rates: retrospective cohort study using linked data from a national intervention programme

Fyfe

Telfar²,

Howden‐Chapman

et al. 2020

BMJ

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Objectives To investigate whether retrofitting insulation into homes can reduce cold associated hospital admission rates among residents and to identify whether the effect varies between different groups within the population and by type of insulation. Design A quasi-experimental retrospective cohort study using linked datasets to evaluate a national intervention programme. Participants 994 317 residents of 204 405 houses who received an insulation subsidy through the Energy Efficiency and Conservation Authority Warm-up New Zealand: Heat Smart retrofit programme between July 2009 and June 2014. Main outcome measure A difference-in-difference approach was used to compare the change in hospital admissions of the study population post-insulation with the change in hospital admissions of the control population that did not receive the intervention over the same two timeframes. Relative rate ratios were used to compare the two groups. Results 234 873 hospital admissions occurred during the study period. Hospital admission rates after the intervention increased in the intervention and control groups for all population categories and conditions with the exception of acute hospital admissions among Pacific Peoples (rate ratio 0.94, 95% confidence interval 0.90 to 0.98), asthma (0.92, 0.86 to 0.99), cardiovascular disease (0.90, 0.88 to 0.93), and ischaemic heart disease for adults older than 65 years (0.79, 0.74 to 0.84). Post-intervention increases were, however, significantly lower (11%) in the intervention group compared with the control group (relative rate ratio 0.89, 95% confidence interval 0.88 to 0.90), representing 9.26 (95% confidence interval 9.05 to 9.47) fewer hospital admissions per 1000 in the intervention population. Effects were more pronounced for respiratory disease (0.85, 0.81 to 0.90), asthma in all age groups (0.80, 0.70 to 0.90), and ischaemic heart disease in those older than 65 years (0.75, 0.66 to 0.83). Conclusion This study showed that a national home insulation intervention was associated with reduced hospital admissions, supporting previous research, which found an improvement in self-reported health.

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Section: Discussionmentioning

confidence: 99%

Association between home insulation and hospital admission rates: retrospective cohort study using linked data from a national intervention programme

Fyfe

Telfar²,

Howden‐Chapman

et al. 2020

BMJ

View full text Add to dashboard Cite

show abstract

“…We propose that there was insufficient opportunity to alter established behaviour and ill health to result in significant reductions in health events, despite the potentially long follow-up periods during this decade-long intervention evaluation. 10 Equally, despite a lack of statistical significance, it is possible there was a practical effect. The people with pre-existing respiratory conditions and CMDs may have experienced an effect on their health service utilisation, compared with the reference group, that would have been significant had the sample size been larger.…”

Section: Discussionmentioning

confidence: 99%

“…9 A simplified version of this logic model was tailored to the GoWell programme. 10 We have adapted the housing improvements to health pathways for the CHS intervention ( Table 1).…”

Section: Logic Model Of Housing Improvementsmentioning

confidence: 99%

Health impact, and economic value, of meeting housing quality standards: a retrospective longitudinal data linkage study

et al. 2018

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BackgroundPoor-quality housing adversely affects residents’ health but there is a paucity of high-quality evidence to support this.ObjectiveThis research investigated the health impact of bringing housing to a national quality standard.DesignA natural experiment of improvements to housing quality analysed using repeated measures of health-care utilisation and economic outcomes at an individual person level.SettingCarmarthenshire, UK.ParticipantsA total of 32,009 residents registered for a minimum of 60 days at 8558 social homes that received housing improvements between January 2005 and March 2015.InterventionsMultiple internal and external housing improvements, including wall and loft insulation, windows and doors, heating system upgrades, new kitchens and bathrooms, garden path safety improvements and electrical system upgrades (adding power sockets, and extractor fans in kitchens and bathrooms).Main outcome measuresEmergency hospital admissions for cardiorespiratory conditions and injuries. Primary health-care utilisation for respiratory and common mental health disorders, emergency department injury attendances and health-care utilisation costs.Data sourcesCarmarthenshire County Council home address and intervention records were anonymously linked within the Secure Anonymous Information Linkage databank to demographic information from the Welsh Demographic Service data set; hospital admission data from the Patient Episode Dataset for Wales; primary care contacts and prescribed medications from general practice data; emergency department attendances from the Emergency Department Data Set; and deaths from the Office for National Statistics mortality register.MethodsThe study used a longitudinal panel design to examine changes in standard of eight housing cointervention from intervention records, and linked to individuals registered at intervention homes. Health outcomes were obtained retrospectively for each individual in a dynamic cohort and were captured for up to 123 consecutive months. An additional local authority region could not be utilised as a comparator owing to different reporting pressures resulting in the recording of a different intervention. The exposure group for each cointervention was compared with an internal reference group of people living in homes that did not receive the cointervention during their tenancy. A multilevel modelling approach was used to account for repeated observations for individuals living in intervention homes. Counts of health outcomes were analysed using negative binomial regression models to determine the effect of each cointervention that reached housing quality standards during an individual’s period of tenancy, compared with those living in properties that did not. We adjusted for potential confounding factors and for background trends in the regional general population. A cost–consequences analysis was conducted as part of the health economic evaluation.ResultsResidents aged ≥ 60 years living in homes in which electrical systems were upgraded were associated with 39% fewer admissions than those living in homes in which they were not [incidence rate ratio (IRR) 0.61, 95% confidence interval (CI) 0.53 to 0.72;p < 0.01]. Reduced admissions were also associated with windows and doors (IRR 0.71, 95% CI 0.63 to 0.81;p < 0.01), wall insulation (IRR 0.75, 95% CI 0.67 to 0.84;p < 0.01) and gardens and estates (IRR 0.73, 95% CI 0.64 to 0.83;p < 0.01) for those living in homes in which these cointervention were upgraded. There were no associations of change in emergency admissions with upgrading heating (IRR 0.91, 95% CI 0.82 to 1.01;p = 0.072), loft insulation (IRR 0.98, 95% CI 0.86 to 1.11;p = 0.695), kitchens (IRR 0.98, 95% CI 0.83 to 1.17;p = 0.843) or bathrooms (IRR 0.93, 95% CI 0.81 to 1.06;p = 0.287).LimitationsThere was no randomisation, there were incomplete data on the scale of the intervention for individual households and there were no estimates for the impact of the whole programme.ConclusionsThis complex interdisciplinary study found that hospital admissions could be avoided through improving housing quality standards.Future workAt their initiation, future non-health projects should have a built-in evaluation to allow intervention exposures to be randomly allocated to residents, with the simultaneous analysis of multiple health outcomes in one statistical model.FundingThe National Institute for Health Research Public Health Research programme.

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“…Evidence on the subject can be found for a wide range of settings [6–7] and populations [5; 8]. The UK has been a major focus for research in this area [1].…”

Section: Introductionmentioning

confidence: 99%

Facework and trust in facilitating health-focused housing interventions

et al. 2017

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The link between housing and health is of increasing importance in the UK policy and practice context, in which poor housing is often accepted as a social determinant of poor health. Service users’ experiences of, and outcomes from, a British information, advice, support and guidance service focused on the relationship between housing problems and health issues were explored. This service facilitates home improvements for privately housed residents with housing issues exacerbating or causing health problems. In-depth interviews with occupants of 15 households which received the service were completed. The findings highlighted three key themes: the need for participants’ person-home fit to reflect and adapt to any degeneration in health conditions; the facilitation of knowledge and access to housing and other support available to them; and perceived positive health and wellbeing outcomes from the receipt of personalised advice and support. The delivery of these outcomes by a named officer of the service team, and the relationship this developed with the service user, are considered within the context of facework, whereby they became a trusted source of guidance in navigating a complex system of assistance. These findings add to the growing knowledge base on housing and health, and also highlight the critical importance of a facework approach in allowing service users to navigate complex systems in order to achieve beneficial outcomes.

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Can housing improvements cure or prevent the onset of health conditions over time in deprived areas?

Cited by 23 publications

References 33 publications

Association between home insulation and hospital admission rates: retrospective cohort study using linked data from a national intervention programme

Association between home insulation and hospital admission rates: retrospective cohort study using linked data from a national intervention programme

Health impact, and economic value, of meeting housing quality standards: a retrospective longitudinal data linkage study

Facework and trust in facilitating health-focused housing interventions

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