Warm homes for older people: aims and methods of a randomised community-based trial for people with COPD

Viggers, Helen; Howden‐Chapman, Philippa; Ingham, Tristram; Chapman, Ralph; Pene, Gina; Davies, Cheryl; Currie, Ann; Pierse, Nevil; Wilson, Helen; Zhang, Jingyan; Baker, Michael G; Crane, Julian

doi:10.1186/1471-2458-13-176

Cited by 22 publications

(18 citation statements)

References 51 publications

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“…A number of prior studies have examined the impacts of housing interventions on COPD, and COPD forms an important part of the overall burden of disease. 118,145,146 In order to identify utility values for COPD to enable contextualisation of the results, a systematic approach was taken to reviewing the literature. The literature review is provided in Appendix 12.…”

Section: Discussionmentioning

confidence: 99%

The health impacts of energy performance investments in low-income areas: a mixed-methods approach

et al. 2018

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BackgroundCold homes and fuel poverty contribute to health inequalities in ways that could be addressed through energy efficiency interventions.ObjectivesTo determine the health and psychosocial impacts of energy performance investments in low-income areas, particularly hospital admissions for cardiorespiratory conditions, prevalence of respiratory symptoms and mental health status, hydrothermal conditions and household energy use, psychosocial outcomes, cost consequences to the health system and the cost utility of these investments.DesignA mixed-methods study comprising data linkage (25,908 individuals living in 4968 intervention homes), a field study with a controlled pre-/post-test design (intervention,n = 418; control,n = 418), a controlled multilevel interrupted time series analysis of internal hydrothermal conditions (intervention,n = 48; control,n = 40) and a health economic assessment.SettingLow-income areas across Wales.ParticipantsResidents who received energy efficiency measures through the intervention programme and matched control groups.Main outcome measuresPrimary outcomes – emergency hospital admissions for cardiorespiratory conditions, self-reported respiratory symptoms, mental health status, indoor air temperature and indoor relative humidity. Secondary outcomes – emergency hospital admissions for chronic obstructive pulmonary disease-related cardiorespiratory conditions, excess winter admissions, health-related quality of life, subjective well-being, self-reported fuel poverty, financial stress and difficulties, food security, social interaction, thermal satisfaction and self-reported housing conditions.MethodsAnonymously linked individual health records for emergency hospital admissions were analysed using mixed multilevel linear models. A quasi-experimental controlled field study used a multilevel repeated measures approach. Controlled multilevel interrupted time series analyses were conducted to estimate changes in internal hydrothermal conditions following the intervention. The economic evaluation comprised cost–consequence and cost–utility analyses.Data sourcesThe Patient Episode Database for Wales 2005–14, intervention records from 28 local authorities and housing associations, and scheme managers who delivered the programme.ResultsThe study found no evidence of changes in physical health. However, there were improvements in subjective well-being and a number of psychosocial outcomes. The household monitoring study found that the intervention raised indoor temperature and helped reduce energy use. No evidence was found of substantial increases in indoor humidity levels. The health economic assessment found no explicit cost reductions to the health service as a result of non-significant changes in emergency admissions for cardiorespiratory conditions.LimitationsThis was a non-randomised intervention study with household monitoring and field studies that relied on self-response. Data linkage focused on emergency admissions only.ConclusionAlthough there was no evidence that energy performance investments provide physical health benefits or reduce health service usage, there was evidence that they improve social and economic conditions that are conducive to better health and improved subjective well-being. The intervention has been successful in reducing energy use and improving the living conditions of households in low-income areas. The lack of association of emergency hospital admissions with energy performance investments means that we were unable to evidence cost saving to health-service providers.Future workOur research suggests the importance of incorporating evaluations with follow-up into intervention research from the start.FundingThe National Institute for Health Research Public Health Research programme.

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Section: Discussionmentioning

confidence: 99%

The health impacts of energy performance investments in low-income areas: a mixed-methods approach

et al. 2018

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“…People living with a chronic health condition may be especially reliant on energy-dependent devices for treatment or maintenance of their condition, lowering their ability to withstand inadequate or unavailable energy services. For example, patients with kidney disease, chronic obstructive pulmonary disease (COPD), and cardiovascular disease (CVD) rely on dialysis and oxygen machines that require electricity (72) and diabetics must refrigerate their insulin. Cancer patients in active treatment need more heat (73), and those suffering from hypertension are more susceptible to cold stress (74).…”

Section: Health Statusmentioning

confidence: 99%

Energy, Poverty, and Health in Climate Change: A Comprehensive Review of an Emerging Literature

Jessel

Sawyer

Hernández

2019

Front. Public Health

228

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Household energy is increasingly vital for maintaining good health. Unaffordable and inadequate household energy presents adverse consequences that are amplified by poverty and a changing climate. To date, the connections between energy, socioeconomic disadvantage, and well-being are generally underappreciated, and household energy connection with climate change is under-researched. Building on the energy insecurity framework, this review explores literature related to household energy, poverty, and health in order to highlight the disproportionate burdens borne by vulnerable populations in adequately meeting household energy needs. This paper is based on a comprehensive review of books, peer-reviewed articles, and reports published between 1990 and 2019, identified via databases including JSTOR and PubMed. A total of 406 publications were selected as having potential for full review, 203 received full review, and 162 were included in this paper on the basis of set inclusion criteria. From the literature review, we created an original heuristic model that describes energy insecurity as either acute or chronic, and we further explore the mediators and pathways that link energy insecurity to health. In the discussion, we posit that the extant literature does not sufficiently consider that vulnerable communities often experience energy insecurity bundled with other hardships. We also discuss energy, poverty, and health through the lens of climate change, making the criticism that most research on household energy does not consider climate change. This evidence is important for enhancing research in this field and developing programmatic and policy interventions as they pertain to energy access, affordability, and health, with special emphasis on vulnerable populations, climate change, and social inequality.

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“…Furthermore, defining the harmful impact of indoor air quality on COPD morbidity is of utmost importance as indoor air pollution is a highly modifiable exposure. Feasible interventions that improve in-home air quality (111–113) and optimize indoor temperature (114) may represent cost-effective and novel therapeutic arenas for a disease with limited treatment options.…”

Section: Indoor Air Pollution and Copdmentioning

confidence: 99%

The Effects of Air Pollution and Temperature on COPD

Hansel

McCormack

Kim

2015

COPD: Journal of Chronic Obstructive Pulmonary Disease

209

116

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Chronic Obstructive Pulmonary Disease (COPD) affects 12–16 million people in the United States and is the third-leading cause of death. In developed countries, smoking is the greatest risk factor for the development of COPD, but other exposures also contribute to the development and progression of the disease. Several studies suggest, though are not definitive, that outdoor air pollution exposure is linked to the prevalence and incidence of COPD. Among individuals with COPD, outdoor air pollutants are associated with loss of lung function and increased respiratory symptoms. In addition, outdoor air pollutants are also associated with COPD exacerbations and mortality. There is much less evidence for the impact of indoor air on COPD, especially in developed countries in residences without biomass exposure. The limited existing data suggests that indoor particulate matter and nitrogen dioxide concentrations are linked to increased respiratory symptoms among patients with COPD. In addition, with the projected increases in temperature and extreme weather events in the context of climate change there has been increased attention to the effects of heat exposure. Extremes of temperature—both heat and cold—have been associated with increased respiratory morbidity in COPD. Some studies also suggest that temperature may modify the effect of pollution exposure and though results are not conclusive, understanding factors that may modify susceptibility to air pollution in patients with COPD is of utmost importance.

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Warm homes for older people: aims and methods of a randomised community-based trial for people with COPD

Cited by 22 publications

References 51 publications

The health impacts of energy performance investments in low-income areas: a mixed-methods approach

The health impacts of energy performance investments in low-income areas: a mixed-methods approach

Energy, Poverty, and Health in Climate Change: A Comprehensive Review of an Emerging Literature

The Effects of Air Pollution and Temperature on COPD

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