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Geary RS, Thompson DA, Garrett JK, Mizen A, Rowney FM, Song J, White MP, Lovell R, Watkins A, Lyons RA, Williams S, Stratton G, Akbari A, Parker SC, Nieuwenhuijsen MJ, White J, Wheeler BW, Fry R, Tsimpida D, Rodgers SE. Green-blue space exposure changes and impact on individual-level well-being and mental health: a population-wide dynamic longitudinal panel study with linked survey data. PUBLIC HEALTH RESEARCH 2023; 11:1-176. [PMID: 37929711 DOI: 10.3310/lqpt9410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023] Open
Abstract
Background Cross-sectional evidence suggests that living near green and blue spaces benefits mental health; longitudinal evidence is limited. Objectives To quantify the impact of changes in green and blue spaces on common mental health disorders, well-being and health service use. Design A retrospective, dynamic longitudinal panel study. Setting Wales, UK. Participants An e-cohort comprising 99,682,902 observations of 2,801,483 adults (≥ 16 years) registered with a general practice in Wales (2008-2019). A 5312-strong 'National Survey for Wales (NSW) subgroup' was surveyed on well-being and visits to green and blue spaces. Main outcome measures Common mental health disorders, general practice records; subjective well-being, Warwick-Edinburgh Mental Well-being Scale. Data sources Common mental health disorder and use of general practice services were extracted quarterly from the Welsh Longitudinal General Practice Dataset. Annual ambient greenness exposure, enhanced vegetation index and access to green and blue spaces (2018) from planning and satellite data. Data were linked within the Secure Anonymised Information Linkage Databank. Methods Multilevel regression models examined associations between exposure to green and blue spaces and common mental health disorders and use of general practice. For the National Survey for Wales subgroup, generalised linear models examined associations between exposure to green and blue spaces and subjective well-being and common mental health disorders. Results and conclusions Our longitudinal analyses found no evidence that changes in green and blue spaces through time impacted on common mental health disorders. However, time-aggregated exposure to green and blue spaces contrasting differences between people were associated with subsequent common mental health disorders. Similarly, our cross-sectional findings add to growing evidence that residential green and blue spaces and visits are associated with well-being benefits: Greater ambient greenness (+ 1 enhanced vegetation index) was associated with lower likelihood of subsequently seeking care for a common mental health disorder [adjusted odds ratio (AOR) 0.80, 95% confidence interval, (CI) 0.80 to 0.81] and with well-being with a U-shaped relationship [Warwick-Edinburgh Mental Well-being Scale; enhanced vegetation index beta (adjusted) -10.15, 95% CI -17.13 to -3.17; EVI2 beta (quadratic term; adj.) 12.49, 95% CI 3.02 to 21.97]. Those who used green and blue spaces for leisure reported better well-being, with diminishing extra benefit with increasing time (Warwick-Edinburgh Mental Well-being Scale: time outdoors (hours) beta 0.88, 95% CI 0.53 to 1.24, time outdoors2 beta -0.06, 95% CI -0.11 to -0.01) and had 4% lower odds of seeking help for common mental health disorders (AOR 0.96, 95% CI 0.93 to 0.99). Those in urban areas benefited most from greater access to green and blue spaces (AOR 0.89, 95% CI 0.89 to 0.89). Those in material deprivation benefited most from leisure time outdoors (until approximately four hours per week; Warwick-Edinburgh Mental Well-being Scale: time outdoors × in material deprivation: 1.41, 95% CI 0.39 to 2.43; time outdoors2 × in material deprivation -0.18, 95% CI -0.33 to -0.04) although well-being remained generally lower. Limitations Longitudinal analyses were restricted by high baseline levels and limited temporal variation in ambient greenness in Wales. Changes in access to green and blue spaces could not be captured annually due to technical issues with national-level planning datasets. Future work Further analyses could investigate mental health impacts in population subgroups potentially most sensitive to local changes in access to specific types of green and blue spaces. Deriving green and blue spaces changes from planning data is needed to overcome temporal uncertainties. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (Project number 16/07/07) and will be published in full in Public Health Research; Vol. 11, No. 10. Sarah Rodgers is part-funded by the NIHR Applied Research Collaboration North West Coast.
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Affiliation(s)
- Rebecca S Geary
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | | | - Joanne K Garrett
- European Centre for Environment and Human Health, University of Exeter Medical School, University of Exeter, Truro, UK
| | - Amy Mizen
- Department of Health Data Science, Swansea University, Swansea, UK
| | - Francis M Rowney
- European Centre for Environment and Human Health, University of Exeter Medical School, University of Exeter, Truro, UK
| | - Jiao Song
- Department of Health Data Science, Swansea University, Swansea, UK
| | - Mathew P White
- European Centre for Environment and Human Health, University of Exeter Medical School, University of Exeter, Truro, UK
| | - Rebecca Lovell
- European Centre for Environment and Human Health, University of Exeter Medical School, University of Exeter, Truro, UK
| | - Alan Watkins
- Department of Health Data Science, Swansea University, Swansea, UK
| | - Ronan A Lyons
- Department of Health Data Science, Swansea University, Swansea, UK
| | | | | | - Ashley Akbari
- Department of Health Data Science, Swansea University, Swansea, UK
| | - Sarah C Parker
- Department of Health Data Science, Swansea University, Swansea, UK
| | | | - James White
- Centre for Trials Research, School of Medicine, Cardiff University, Cardiff, UK
| | - Benedict W Wheeler
- European Centre for Environment and Human Health, University of Exeter Medical School, University of Exeter, Truro, UK
| | - Richard Fry
- Department of Health Data Science, Swansea University, Swansea, UK
| | - Dialechti Tsimpida
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | - Sarah E Rodgers
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
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Jones M, Hill T, Coupland C, Kendrick D, Akbari A, Rodgers S, Watson MC, Tyrrell E, Merrill S, Martin A, Orton E. Cost-effectiveness of England's national 'Safe At Home' scheme for reducing hospital admissions for unintentional injury in children aged under 5. Inj Prev 2023; 29:158-165. [PMID: 36600567 DOI: 10.1136/ip-2022-044698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 11/06/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Injuries in children aged under 5 years most commonly occur in the home and disproportionately affect those living in the most disadvantaged communities. The 'Safe at Home' (SAH) national home safety equipment scheme, which ran in England between 2009 and 2011, has been shown to reduce injury-related hospital admissions, but there is little evidence of cost-effectiveness. MATERIALS AND METHODS Cost-effectiveness analysis from a health and local government perspective. Measures were the incremental cost-effectiveness ratio per hospital admission averted (ICER) and cost-offset ratio (COR), comparing SAH expenditure to savings in admission expenditure. The study period was split into three periods: T1 (years 0-2, implementation); T2 (years 3-4) and T3 (years 5-6). Analyses were conducted for T2 versus T1 and T3 versus T1. RESULTS Total cost of SAH was £9 518 066. 202 223 hospital admissions in the children occurred during T1-3, costing £3 320 000. Comparing T3 to T1 SAH reduced admission expenditure by £924 per month per local authority and monthly admission rates by 0.5 per local authority per month compared with control areas. ICER per admission averted was £4209 for T3 versus T1, with a COR of £0.29, suggesting that 29p was returned in savings on admission expenditure for every pound spent on SAH. CONCLUSION SAH was effective at reducing hospital admissions due to injury and did result in some cost recovery when taking into admissions only. Further analysis of its cost-effectiveness, including emergency healthcare, primary care attendances and wider societal costs, is likely to improve the return on investment further.
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Affiliation(s)
- Matthew Jones
- Unit of Lifespan and Population Health, University of Nottingham Faculty of Medicine and Health Sciences, Nottingham, UK
| | - Trevor Hill
- Unit of Lifespan and Population Health, University of Nottingham Faculty of Medicine and Health Sciences, Nottingham, UK
| | - Carol Coupland
- Unit of Lifespan and Population Health, University of Nottingham Faculty of Medicine and Health Sciences, Nottingham, UK
| | - Denise Kendrick
- Unit of Lifespan and Population Health, University of Nottingham Faculty of Medicine and Health Sciences, Nottingham, UK
| | - Ashley Akbari
- Faculty of Medicine, Health, & Life Science, University of Wales Swansea, Swansea, UK
| | - Sarah Rodgers
- Department of Public Health, Policy & Systems, University of Liverpool, Liverpool, UK
| | | | - Edward Tyrrell
- Unit of Lifespan and Population Health, University of Nottingham, Nottingham, UK
| | - Sheila Merrill
- Royal Society for the Prevention of Accidents (RoSPA), Edgbaston, UK
| | - Ashley Martin
- Royal Society for the Prevention of Accidents (RoSPA), Edgbaston, UK
| | - Elizabeth Orton
- Unit of Lifespan and Population Health, University of Nottingham Faculty of Medicine and Health Sciences, Nottingham, UK
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Petersen J, Alexiou A, Brewerton D, Cornelsen L, Courtin E, Cummins S, Marks D, Seguin M, Stewart J, Thompson K, Egan M. Impact of selective licensing schemes for private rental housing on mental health and social outcomes in Greater London, England: a natural experiment study. BMJ Open 2022; 12:e065747. [PMID: 36564110 PMCID: PMC9791445 DOI: 10.1136/bmjopen-2022-065747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES To assess primary impact of selective Licensing (SL), an area-based intervention in the private rented housing market, on individual self-reported anxiety and neighbourhood mental health (MHI-Mental Healthcare Index) and secondary impacts on antisocial behaviour (ASB), population turnover and self-reported well-being. DESIGN Difference-in-difference (DiD) was used to evaluate effects of SL schemes initiated 2012-2018. 921 intervention areas (lower super output areas) were matched 3:1 using propensity scores derived from sociodemographic and housing variables (N=3.684 including controls). Average treatment effect on treated (ATT) was calculated for multiple time period DiD in area-level analyses. Canonical DiD was used for individual-level analysis by year of treatment initiation while adjusting for age, sex, native birth and occupational class. SETTING Intervention neighbourhoods and control areas in Greater London, UK, 2011-2019. PARTICIPANTS We sampled 4474 respondents renting privately in intervention areas (N=17 347 including controls) in Annual Population Survey and obtained area-level MHI population data. INTERVENTIONS Private landlords in SL areas must obtain a licence from the local authority, allow inspection and maintain minimum housing standards. RESULTS ATT after 5 years was significantly lower for MHI (-7.5%, 95% CI -5.6% to -8.8%) than controls. Antidepressant treatment days per population reduced by -5.4% (95% CI -3.7% to -7.3), mental health benefit receipt by -9.6% (95% CI -14% to -5.5%) and proportion with depression by -12% (95% CI -7.7% to -16.3%). ASB reduced by -15% (95% CI -21% to -8.2%). Population turnover increased by 26.5% (95% CI 22.1% to 30.8%). Sensitivity analysis suggests overlap with effects of London 2012 Olympic regeneration. No clear patterns were observed for self-reported anxiety. CONCLUSIONS We found associations between SL and reductions in area-based mental healthcare outcomes and ASB, while population turnover increased. A national evaluation of SL is feasible and necessary.
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Affiliation(s)
- Jakob Petersen
- Public Health, Environments & Society, London School of Hygiene and Tropical Medicine, London, UK
| | - Alexandros Alexiou
- Department of Public Health and Policy, University of Liverpool Faculty of Health and Life Sciences, Liverpool, UK
| | | | - Laura Cornelsen
- Public Health, Environments & Society, London School of Hygiene and Tropical Medicine, London, UK
| | - Emilie Courtin
- Public Health, Environments & Society, London School of Hygiene and Tropical Medicine, London, UK
| | - Steven Cummins
- Public Health, Environments & Society, London School of Hygiene and Tropical Medicine, London, UK
| | - Dalya Marks
- Public Health, Environments & Society, London School of Hygiene and Tropical Medicine, London, UK
| | - Maureen Seguin
- Public Health, Environments & Society, London School of Hygiene and Tropical Medicine, London, UK
| | - Jill Stewart
- School of Science & Technology, Department of Natural Sciences, Middlesex University, London, UK
| | - Kevin Thompson
- Head of Private Sector Housing, London Borough of Hackney, London, UK
| | - Matt Egan
- Public Health, Environments & Society, London School of Hygiene and Tropical Medicine, London, UK
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Thompson DA, Geary RS, Rowney FM, Fry R, Watkins A, Wheeler BW, Mizen A, Akbari A, Lyons RA, Stratton G, White J, Rodgers SE. Cohort Profile: The Green and Blue Spaces (GBS) and mental health in Wales e-cohort. Int J Epidemiol 2022; 51:e285-e294. [PMID: 35446420 PMCID: PMC9558062 DOI: 10.1093/ije/dyac080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 04/05/2022] [Indexed: 11/30/2022] Open
Affiliation(s)
- Daniel A Thompson
- Population Data Science, Swansea University Medical School, Faculty of Medicine, Health and Life Science, Swansea University, Swansea UK
| | - Rebecca S Geary
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | - Francis M Rowney
- European Centre for Environment and Human Health, University of Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital, Cornwall, UK
| | - Richard Fry
- Population Data Science, Swansea University Medical School, Faculty of Medicine, Health and Life Science, Swansea University, Swansea UK
| | - Alan Watkins
- Population Data Science, Swansea University Medical School, Faculty of Medicine, Health and Life Science, Swansea University, Swansea UK
| | - Benedict W Wheeler
- European Centre for Environment and Human Health, University of Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital, Cornwall, UK
| | - Amy Mizen
- Population Data Science, Swansea University Medical School, Faculty of Medicine, Health and Life Science, Swansea University, Swansea UK
| | - Ashley Akbari
- Population Data Science, Swansea University Medical School, Faculty of Medicine, Health and Life Science, Swansea University, Swansea UK
| | - Ronan A Lyons
- Population Data Science, Swansea University Medical School, Faculty of Medicine, Health and Life Science, Swansea University, Swansea UK
| | - Gareth Stratton
- Department of Sport and Exercise Sciences, Applied Sports Technology, Exercise and Medicine A-STEM Research Centre, School of Engineering and Applied Sciences, Faculty of Science and Engineering, Swansea University, Swansea UK
| | - James White
- Centre for Trials Research, School of Medicine, Cardiff University, Cardiff, UK
| | - Sarah E Rodgers
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
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Hunter RF, Rodgers SE, Hilton J, Clarke M, Garcia L, Ward Thompson C, Geary R, Green MA, O'Neill C, Longo A, Lovell R, Nurse A, Wheeler BW, Clement S, Porroche-Escudero A, Mitchell R, Barr B, Barry J, Bell S, Bryan D, Buchan I, Butters O, Clemens T, Clewley N, Corcoran R, Elliott L, Ellis G, Guell C, Jurek-Loughrey A, Kee F, Maguire A, Maskell S, Murtagh B, Smith G, Taylor T, Jepson R. GroundsWell: Community-engaged and data-informed systems transformation of Urban Green and Blue Space for population health - a new initiative. Wellcome Open Res 2022; 7:237. [PMID: 36865374 PMCID: PMC9971655 DOI: 10.12688/wellcomeopenres.18175.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2022] [Indexed: 11/20/2022] Open
Abstract
Natural environments, such as parks, woodlands and lakes, have positive impacts on health and wellbeing. Urban Green and Blue Spaces (UGBS), and the activities that take place in them, can significantly influence the health outcomes of all communities, and reduce health inequalities. Improving access and quality of UGBS needs understanding of the range of systems (e.g. planning, transport, environment, community) in which UGBS are located. UGBS offers an ideal exemplar for testing systems innovations as it reflects place-based and whole society processes , with potential to reduce non-communicable disease (NCD) risk and associated social inequalities in health. UGBS can impact multiple behavioural and environmental aetiological pathways. However, the systems which desire, design, develop, and deliver UGBS are fragmented and siloed, with ineffective mechanisms for data generation, knowledge exchange and mobilisation. Further, UGBS need to be co-designed with and by those whose health could benefit most from them, so they are appropriate, accessible, valued and used well. This paper describes a major new prevention research programme and partnership, GroundsWell, which aims to transform UGBS-related systems by improving how we plan, design, evaluate and manage UGBS so that it benefits all communities, especially those who are in poorest health. We use a broad definition of health to include physical, mental, social wellbeing and quality of life. Our objectives are to transform systems so that UGBS are planned, developed, implemented, maintained and evaluated with our communities and data systems to enhance health and reduce inequalities. GroundsWell will use interdisciplinary, problem-solving approaches to accelerate and optimise community collaborations among citizens, users, implementers, policymakers and researchers to impact research, policy, practice and active citizenship. GroundsWell will be shaped and developed in three pioneer cities (Belfast, Edinburgh, Liverpool) and their regional contexts, with embedded translational mechanisms to ensure that outputs and impact have UK-wide and international application.
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Affiliation(s)
- Ruth F. Hunter
- Centre for Public Health, Queen's University Belfast, Belfast, UK,
| | - Sarah E. Rodgers
- Department of Public Health, Policy & Systems, University of Liverpool, Liverpool, UK,
| | - Jeremy Hilton
- School of Defence and Security, Cranfield University, Bedfordshire, UK
| | - Mike Clarke
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Leandro Garcia
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | | | - Rebecca Geary
- Department of Public Health, Policy & Systems, University of Liverpool, Liverpool, UK
| | - Mark A. Green
- Department of Geography & Planning, University of Liverpool, Liverpool, UK
| | - Ciaran O'Neill
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Alberto Longo
- School of Biological Sciences, Queen's University Belfast, Belfast, UK
| | - Rebecca Lovell
- European Centre for Environment and Human Health, University of Exeter Medical School, Truro, UK
| | - Alex Nurse
- Department of Geography & Planning, University of Liverpool, Liverpool, UK
| | - Benedict W. Wheeler
- European Centre for Environment and Human Health, University of Exeter Medical School, Truro, UK
| | - Sarah Clement
- Department of Geography and Planning, University of Western Australia, Perth, Australia
| | | | - Rich Mitchell
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Ben Barr
- Department of Public Health, Policy & Systems, University of Liverpool, Liverpool, UK
| | - John Barry
- School of History, Anthropology, Philosophy and Politics, Queen's University Belfast, Belfast, UK
| | - Sarah Bell
- European Centre for Environment and Human Health, University of Exeter Medical School, Truro, UK
| | - Dominic Bryan
- School of History, Anthropology, Philosophy and Politics, Queen's University Belfast, Belfast, UK
| | - Iain Buchan
- Department of Public Health, Policy & Systems, University of Liverpool, Liverpool, UK
| | - Olly Butters
- Department of Public Health, Policy & Systems, University of Liverpool, Liverpool, UK
| | - Tom Clemens
- School of Geosciences, University of Edinburgh, Edinburgh, UK
| | - Natalie Clewley
- School of Defence and Security, Cranfield University, Bedfordshire, UK
| | - Rhiannon Corcoran
- Primary Care and Mental Health, University of Liverpool, Liverpool, UK
| | - Lewis Elliott
- European Centre for Environment and Human Health, University of Exeter Medical School, Truro, UK
| | - Geraint Ellis
- School of Natural and Built Environment, Queen's University Belfast, Belfast, UK
| | - Cornelia Guell
- European Centre for Environment and Human Health, University of Exeter Medical School, Truro, UK
| | - Anna Jurek-Loughrey
- School of Electronics, Electrical Engineering and Computer Science, Queen's University Belfast, Belfast, UK
| | - Frank Kee
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Aideen Maguire
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Simon Maskell
- Electrical Engineering and Electronics, University of Liverpool, Liverpool, UK
| | - Brendan Murtagh
- School of Natural and Built Environment, Queen's University Belfast, Belfast, UK
| | - Grahame Smith
- Nursing and Allied Health, Liverpool John Moores University, Liverpool, UK
| | - Timothy Taylor
- European Centre for Environment and Human Health, University of Exeter Medical School, Truro, UK
| | - Ruth Jepson
- Scottish Collaboration for Public Health Research and Policy (SCPHRP), University of Edinburgh, Edinburgh, UK,
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Home Energy Upgrades as a Pathway to Home Decarbonization in the US: A Literature Review. ENERGIES 2022. [DOI: 10.3390/en15155590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
This work aims to characterize how home energy upgrade projects and programs in the US have evolved over the past decade. It also identifies what changes are needed to drive expansion of the US energy retrofit market in such a way that addresses carbon emissions from buildings, improves resilience and upgrades the housing stock. This review focuses on whole-home energy upgrades, targeting deep energy retrofit savings of >30%. The topics we cover include trends in home electrification, US and European home energy upgrade programs, energy upgrade measure costs, business economics, and health effects. Key changes in project design noted in this review include: (1) the electrification of dwellings with rapidly improving heat pump systems and low-cost solar photovoltaic technology; and (2) a shift away from high-cost building envelope strategies and towards more traditional home performance/weatherization envelope upgrades. Promising program design strategies covered include: (1) end-use electrification programs; (2) novel financing approaches; (3) the use of carbon-based program and project metrics; and (4) “one-stop shop” programs. Based on the existing market barriers, we suggest that the industry should adopt new project performance metrics. Additionally, market drivers are needed to spur widespread energy upgrades in the US housing stock. Costs must be reduced, and projects designed to appeal to homeowners and contractors.
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Petersen J, Seguin M, Alexiou A, Cornelsen L, Courtin E, Cummins S, Marks D, Egan M. Assessing the impact of selective licencing schemes for private rental housing on mental health and well-being: protocol for a mixed-method natural experiment study in Greater London, UK. BMJ Open 2022; 12:e057711. [PMID: 35623746 PMCID: PMC9150155 DOI: 10.1136/bmjopen-2021-057711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The UK private rental housing market has poorer quality housing compared with other sectors and is subjected to calls for better regulation. Poor quality housing poses risks to mental and physical health, and housing improvement can potentially benefit health and well-being. Local authorities have powers to implement selective licencing (SL) schemes in specific localities. Such schemes involve landlord registration, payment of licence fees, local authority inspection and requirements that landlords conduct any necessary renovation works to ensure housing standards are met. We aim to evaluate SL in Greater London and to test the feasibility of a national evaluation. METHODS AND ANALYSIS We will measure individual-level and area-level impacts of SL in Greater London between 2011 and 2019. A difference-in-differences approach with propensity score-matched controls will be used. We propose to exploit data from the Annual Population Survey (APS) and health and social benefit registers to measure mental health and well-being at individual (self-reported anxiety) and area (Small Area Mental Health Index) level. We estimate 633 APS participants in our intervention groups compared with 1899 participants in control areas (1:3 ratio of intervention to control). Secondary outcomes will be self-reported well-being and residential stability at the individual level and incidence of police-recorded antisocial behaviour calls and population turnover at the area level. The study size of the area-level analyses will be 3684 lower layer super output areas (including controls). Qualitative semistructured interviews with lead implementers in several London boroughs will produce insights into variations and commonalities between schemes. ETHICS AND DISSEMINATION Ethical approval was obtained from London School of Hygiene and Tropical Medicine's Ethics Committee (reference number 26481) and London Borough of Hackney. All interviewees will be asked for informed written consent. Study findings will be published in a peer-reviewed journal.
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Affiliation(s)
- Jakob Petersen
- Public Health, Environments & Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Maureen Seguin
- Public Health, Environments & Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Alexandros Alexiou
- Department of Public Health and Policy, University of Liverpool Faculty of Health and Life Sciences, Liverpool, UK
| | - Laura Cornelsen
- Public Health, Environments & Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Emilie Courtin
- Public Health, Environments & Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Steven Cummins
- Public Health, Environments & Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Dalya Marks
- Public Health, Environments & Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Matt Egan
- Public Health, Environments & Society, London School of Hygiene & Tropical Medicine, London, UK
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Campbell M, Page K, Longden T, Kenny P, Hossain L, Wilmot K, Kelly S, Kim Y, Haywood P, Mulhern B, Goodall S, van Gool K, Viney R, Cumming T, Soeberg M. Evaluation of the Victorian Healthy Homes Program: protocol for a randomised controlled trial. BMJ Open 2022; 12:e053828. [PMID: 35459665 PMCID: PMC9036464 DOI: 10.1136/bmjopen-2021-053828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The evaluation of the Victorian Healthy Homes Program (VHHP) will generate evidence about the efficacy and cost-effectiveness of home upgrades to improve thermal comfort, reduce energy use and produce health and economic benefits to vulnerable households in Victoria, Australia. METHODS AND ANALYSIS The VHHP evaluation will use a staggered, parallel group clustered randomised controlled trial to test the home energy intervention in 1000 households. All households will receive the intervention either before (intervention group) or after (control group) winter (defined as 22 June to 21 September). The trial spans three winters with differing numbers of households in each cohort. The primary outcome is the mean difference in indoor average daily temperature between intervention and control households during the winter period. Secondary outcomes include household energy consumption and residential energy efficiency, self-reported respiratory symptoms, health-related quality of life, healthcare utilisation, absences from school/work and self-reported conditions within the home. Linear and logistic regression will be used to analyse the primary and secondary outcomes, controlling for clustering of households by area and the possible confounders of year and timing of intervention, to compare the treatment and control groups over the winter period. Economic evaluation will include a cost-effectiveness and cost-benefit analysis. ETHICS AND DISSEMINATION Ethical approval was received from Victorian Department of Human Services Human Research Ethics Committee (reference number: 04/17), University of Technology Sydney Human Research Ethics Committee (reference number: ETH18-2273) and Australian Government Department of Veterans Affairs. Study results will be disseminated in a final report and peer-reviewed journals. TRIAL REGISTRATION NUMBER ACTRN12618000160235.
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Affiliation(s)
- Margaret Campbell
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Katie Page
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Thomas Longden
- Australian National University, Canberra, Australian Capital Territory, Australia
| | - Patricia Kenny
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Lutfun Hossain
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Kerryn Wilmot
- Institute for Sustainable Futures, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Scott Kelly
- Institute for Sustainable Futures, University of Technology Sydney, Sydney, New South Wales, Australia
| | - YoHan Kim
- Institute for Sustainable Futures, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Philip Haywood
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Brendan Mulhern
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Stephen Goodall
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Kees van Gool
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Rosalie Viney
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Toby Cumming
- Sustainability Victoria, Melbourne, Victoria, Australia
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Hill T, Coupland C, Kendrick D, Jones M, Akbari A, Rodgers S, Watson MC, Tyrrell E, Merrill S, Orton E. Impact of the national home safety equipment scheme 'Safe At Home' on hospital admissions for unintentional injury in children under 5: a controlled interrupted time series analysis. J Epidemiol Community Health 2022; 76:53-59. [PMID: 34158405 PMCID: PMC8666806 DOI: 10.1136/jech-2021-216613] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 05/31/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND Unintentional home injuries are a leading cause of preventable death in young children. Safety education and equipment provision improve home safety practices, but their impact on injuries is less clear. Between 2009 and 2011, a national home safety equipment scheme was implemented in England (Safe At Home), targeting high-injury-rate areas and socioeconomically disadvantaged families with children under 5. This provided a 'natural experiment' for evaluating the scheme's impact on hospital admissions for unintentional injuries. METHODS Controlled interrupted time series analysis of unintentional injury hospital admission rates in small areas (Lower Layer Super Output Areas (LSOAs)) in England where the scheme was implemented (intervention areas, n=9466) and matched with LSOAs in England and Wales where it was not implemented (control areas, n=9466), with subgroup analyses by density of equipment provision. RESULTS 57 656 homes receiving safety equipment were included in the analysis. In the 2 years after the scheme ended, monthly admission rates declined in intervention areas (-0.33% (-0.47% to -0.18%)) but did not decline in control areas (0.04% (-0.11%-0.19%), p value for difference in trend=0.001). Greater reductions in admission rates were seen as equipment provision density increased. Effects were not maintained beyond 2 years after the scheme ended. CONCLUSIONS A national home safety equipment scheme was associated with a reduction in injury-related hospital admissions in children under 5 in the 2 years after the scheme ended. Providing a higher number of items of safety equipment appears to be more effective in reducing injury rates than providing fewer items.
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Affiliation(s)
- Trevor Hill
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | - Carol Coupland
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | - Denise Kendrick
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | - Matthew Jones
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | | | - Sarah Rodgers
- Public Health and Policy, University of Liverpool, Liverpool, UK
| | | | - Edward Tyrrell
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | - Sheila Merrill
- Royal Society for the Prevention of Accidents (RoSPA), Edgbaston, UK
| | - Elizabeth Orton
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
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10
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Rodrigues M, Santana P, Rocha A. Modelling of Temperature-Attributable Mortality among the Elderly in Lisbon Metropolitan Area, Portugal: A Contribution to Local Strategy for Effective Prevention Plans. J Urban Health 2021; 98:516-531. [PMID: 33844122 PMCID: PMC8040763 DOI: 10.1007/s11524-021-00536-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/26/2021] [Indexed: 11/21/2022]
Abstract
Epidemiological studies on the impact of determining environmental factors on human health have proved that temperature extremes and variability constitute mortality risk factors. However, few studies focus specifically on susceptible individuals living in Portuguese urban areas. This study aimed to estimate and assess the health burden of temperature-attributable mortality among age groups (0-64 years; 65-74 years; 75-84 years; and 85+ years) in Lisbon Metropolitan Area, from 1986-2015. Non-linear and delayed exposure-lag-response relationships between temperature and mortality were fitted with a distributed lag non-linear model (DLNM). In general, the adverse effects of cold and hot temperatures on mortality were greater in the older age groups, presenting a higher risk during the winter season. We found that, for all ages, 10.7% (95% CI: 9.3-12.1%) deaths were attributed to cold temperatures in the winter, and mostly due to moderately cold temperatures, 7.0% (95% CI: 6.2-7.8%), against extremely cold temperatures, 1.4% (95% CI: 0.9-1.8%). When stratified by age, people aged 85+ years were more burdened by cold temperatures (13.8%, 95% CI: 11.5-16.0%). However, for all ages, 5.6% of deaths (95% CI: 2.7-8.4%) can be attributed to hot temperatures. It was observed that the proportion of deaths attributed to exposure to extreme heat is higher than moderate heat. As with cold temperatures, people aged 85+ years are the most vulnerable age group to heat, 8.4% (95% CI: 3.9%, 2.7%), and mostly due to extreme heat, 1.3% (95% CI: 0.8-1.8%). These results provide new evidence on the health burdens associated with alert thresholds, and they can be used in early warning systems and adaptation plans.
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Affiliation(s)
- Mónica Rodrigues
- Department of Geography and Tourism, Centre of Studies on Geography and Spatial Planning, University of Coimbra, Coimbra, Portugal.
| | - Paula Santana
- Department of Geography and Tourism, Centre of Studies on Geography and Spatial Planning, University of Coimbra, Coimbra, Portugal
| | - Alfredo Rocha
- Department of Physics, Centre for Environmental and Marine Studies, University of Aveiro, Aveiro, Portugal
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11
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A Review of the Relation between Household Indoor Temperature and Health Outcomes. ENERGIES 2020. [DOI: 10.3390/en13112881] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
This paper provides a review of research that addresses the relationship between indoor temperatures and health outcomes, taking into consideration studies that focus heat or cold exposure within the household context. It aims to extend previous research by considering both indoor temperatures from existing housing, and empirical studies that focus on energy efficiency measures and subsequent health impacts. To achieve this aim, a literature review was undertaken, combining engineering and health databases. The review established that, overall, inadequate indoor temperatures are associated with poor health status, whereas energy efficiency measures have been associated to improved indoor temperatures and occupant’s health namely regarding cardiovascular, respiratory and mental health disorders. These health conditions are among the most prevalent non-communicable diseases (NCD). The review also highlighted the need for more empirical studies with an extended timeframe to deal with climate change challenges. It underlined the potential advantages of the convergence between health and energy efficiency studies, for better modelling and planning.
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12
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Herrmann A, Sauerborn R, Nilsson M. The Role of Health in Households' Balancing Act for Lifestyles Compatible with the Paris Agreement-Qualitative Results from Mannheim, Germany. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E1297. [PMID: 32085458 PMCID: PMC7068404 DOI: 10.3390/ijerph17041297] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 02/07/2020] [Accepted: 02/09/2020] [Indexed: 12/16/2022]
Abstract
Household lifestyles are the main drivers of climate change. Climate change mitigation measures directed to households often have substantial health co-benefits. The European mixed-methods study HOPE (HOuseholds' Preferences for reducing greenhouse gas emissions in four European high-income countries) investigates households' preferences for reducing greenhouse gas emissions and particularly researches the role of information on health co-benefits in households' decision making. The results presented in this study are derived from 18 qualitative interviews, conducted with a subsample of households from Mannheim, Germany. The in-depth interviews were transcribed verbatim, analyzed with a qualitative content analysis, supported by NVivo software. They showed that, in order to reduce their greenhouse gas emission in a way compatible with the 1.5 °C goal, households have to undertake a difficult balancing act, considering factors from the individual sphere, such as health co-benefits, as well as from the public sphere, such as (climate) policies. Shared responsibility and equity are important aspects of households. In conclusion, health is an important factor in households' decision making. However, information policies about health co-benefits need to go along with structural policy measures, in order to support households effectively in the implementation of healthy and climate-friendly lifestyles, especially in sectors where behavior change is difficult, like the mobility sector.
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Affiliation(s)
- Alina Herrmann
- Heidelberg Institute of Global Health (HIGH), Heidelberg University Hospital, 69120 Heidelberg, Germany;
| | - Rainer Sauerborn
- Heidelberg Institute of Global Health (HIGH), Heidelberg University Hospital, 69120 Heidelberg, Germany;
| | - Maria Nilsson
- Department of Epidemiology and Global Health, Umeå University, 90187 Umeå, Sweden;
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13
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Steinmetz-Wood M, Velauthapillai K, O'Brien G, Ross NA. Assessing the micro-scale environment using Google Street View: the Virtual Systematic Tool for Evaluating Pedestrian Streetscapes (Virtual-STEPS). BMC Public Health 2019; 19:1246. [PMID: 31500596 PMCID: PMC6734502 DOI: 10.1186/s12889-019-7460-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 08/08/2019] [Indexed: 11/23/2022] Open
Abstract
Background Altering micro-scale features of neighborhood walkability (e.g., benches, sidewalks, and cues of social disorganization or crime) could be a relatively cost-effective method of creating environments that are conducive to active living. Traditionally, measuring the micro-scale environment has required researchers to perform observational audits. Technological advances have led to the development of virtual audits as alternatives to observational field audits with the enviable properties of cost-efficiency from elimination of travel time and increased safety for auditors. This study examined the reliability of the Virtual Systematic Tool for Evaluating Pedestrian Streetscapes (Virtual-STEPS), a Google Street View-based auditing tool specifically designed to remotely assess micro-scale characteristics of the built environment. Methods We created Virtual-STEPS, a tool with 40 items categorized into 6 domains (pedestrian infrastructure, traffic calming and streets, building characteristics, bicycling infrastructure, transit, and aesthetics). Items were selected based on their past abilities to predict active living and on their feasibility for a virtual auditing tool. Two raters performed virtual and field audits of street segments in Montreal neighborhoods stratified by the Walkscore that was used to determine the ‘walking-friendliness’ of a neighborhood. The reliability between virtual and field audits (n = 40), as well as inter-rater reliability (n = 60) were assessed using percent agreement, Cohen’s Kappa statistic, and the Intra-class Correlation Coefficient. Results Virtual audits and field audits (excluding travel time) took similar amounts of time to perform (9.8 versus 8.2 min). Percentage agreement between virtual and field audits, and for inter-rater agreement was 80% or more for the majority of items included in the Virtual-STEPS tool. There was high reliability between virtual and field audits with Kappa and ICC statistics indicating that 20 out of 40 (50.0%) items had almost perfect agreement and 13 (32.5%) items had substantial agreement. Inter-rater reliability was also high with 17 items (42.5%) with almost perfect agreement and 11 (27.5%) items with substantial agreement. Conclusions Virtual-STEPS is a reliable tool. Tools that measure the micro-scale environment are important because changing this environment could be a relatively cost-effective method of creating environments that are conducive to active living. Electronic supplementary material The online version of this article (10.1186/s12889-019-7460-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Kabisha Velauthapillai
- McGill School of Environment, McGill University, 805 Sherbrooke St W, Montreal, QC, H3A 0B9, Canada
| | - Grace O'Brien
- McGill School of Environment, McGill University, 805 Sherbrooke St W, Montreal, QC, H3A 0B9, Canada
| | - Nancy A Ross
- Department of Geography, McGill University, 805 Sherbrooke St W, Montreal, QC, H3A 0B9, Canada
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14
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Ford E, Boyd A, Bowles JK, Havard A, Aldridge RW, Curcin V, Greiver M, Harron K, Katikireddi V, Rodgers SE, Sperrin M. Our data, our society, our health: A vision for inclusive and transparent health data science in the United Kingdom and beyond. Learn Health Syst 2019; 3:e10191. [PMID: 31317072 PMCID: PMC6628981 DOI: 10.1002/lrh2.10191] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 02/08/2019] [Accepted: 03/06/2019] [Indexed: 01/28/2023] Open
Abstract
The last 6 years have seen sustained investment in health data science in the United Kingdom and beyond, which should result in a data science community that is inclusive of all stakeholders, working together to use data to benefit society through the improvement of public health and well-being. However, opportunities made possible through the innovative use of data are still not being fully realised, resulting in research inefficiencies and avoidable health harms. In this paper, we identify the most important barriers to achieving higher productivity in health data science. We then draw on previous research, domain expertise, and theory to outline how to go about overcoming these barriers, applying our core values of inclusivity and transparency. We believe a step change can be achieved through meaningful stakeholder involvement at every stage of research planning, design, and execution and team-based data science, as well as harnessing novel and secure data technologies. Applying these values to health data science will safeguard a social licence for health data research and ensure transparent and secure data usage for public benefit.
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Affiliation(s)
- Elizabeth Ford
- Department of Primary Care and Public HealthBrighton and Sussex Medical SchoolBrightonUK
| | - Andy Boyd
- ALSPAC, Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
| | | | - Alys Havard
- Centre for Big Data Research in HealthUniversity of New South WalesSydneyAustralia
| | | | - Vasa Curcin
- School of Population and Environmental Health Sciences, Faculty of Life Sciences and MedicineKing's College LondonUK
| | - Michelle Greiver
- Department of Family and Community MedicineUniversity of Toronto, North York General HospitalTorontoCanada
| | - Katie Harron
- Great Ormond Street Institute of Child HealthUCLLondonUK
| | - Vittal Katikireddi
- MRC/CSO Social and Public Health Sciences UnitUniversity of GlasgowGlasgowUK
| | - Sarah E. Rodgers
- Health Data Research UKSwansea UniversitySwanseaUK
- Public Health and PolicyUniversity of LiverpoolLiverpoolUK
| | - Matthew Sperrin
- School of Health Sciences, Faculty of Biology, Medicine and HealthUniversity of ManchesterManchesterUK
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15
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Hollinghurst J, Akbari A, Fry R, Watkins A, Berridge D, Clegg A, Hillcoat-Nalletamby S, Williams N, Lyons R, Mizen A, Walters A, Johnson R, Rodgers S. Study protocol for investigating the impact of community home modification services on hospital utilisation for fall injuries: a controlled longitudinal study using data linkage. BMJ Open 2018; 8:e026290. [PMID: 30381314 PMCID: PMC6224723 DOI: 10.1136/bmjopen-2018-026290] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 09/18/2018] [Accepted: 09/28/2018] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION This study will evaluate the effectiveness of home adaptations, both in preventing hospital admissions due to falls for older people, and improving timely discharge. Results will provide evidence for services at the interface between health and social care, informing policies seeking to promote healthy ageing through prudent healthcare and fall prevention. METHODS AND ANALYSIS All individuals living in Wales, UK, aged 60 years and over, will be included in the study using anonymised linked data from the Secure Anonymised Information Linkage Databank. We will use a national database of home modifications implemented by the charity organisation Care & Repair Cymru (C&R) from 2009 to 2017 to define an intervention cohort. We will use the electronic Frailty Index to assign individual levels of frailty (fit, mild, moderate or severe) and use these to create a comparator group (non-C&R) of people who have not received a C&R intervention. Coprimary outcomes will be quarterly numbers of emergency hospital admissions attributed to falls at home, and the associated length of stay. Secondary outcomes include the time in moving to a care home following a fall, and the indicative financial costs of care for individuals who had a fall. We will use appropriate multilevel generalised linear models to analyse the number of hospital admissions related to falls. We will use Cox proportional hazard models to compare the length of stay for fall-related hospital admissions and the time in moving to a care home between the C&R and non-C&R cohorts. We will assess the impact per frailty group, correct for population migration and adjust for confounding variables. Indicative costs will be calculated using financial codes for individual-level hospital stays. Results will provide evidence for services at the interface between health and social care, informing policies seeking to promote healthy ageing through prudent healthcare and prevention. ETHICS AND DISSEMINATION Information governance requirements for the use of record-linked data have been approved and only anonymised data will be used in our analysis. Our results will be submitted for publication in peer-reviewed journals. We will also work with lay members and the knowledge transfer team at Swansea University to create communication and dissemination materials on key findings.
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Affiliation(s)
- Joe Hollinghurst
- Health Data Research UK (HDR-UK), Swansea University, Swansea, UK
| | - Ashley Akbari
- Health Data Research UK (HDR-UK), Swansea University, Swansea, UK
- Administrative Data Research Centre Wales, Swansea University Medical School, Swansea, UK
| | - Richard Fry
- Health Data Research UK (HDR-UK), Swansea University, Swansea, UK
- National Centre for Population Health and Wellbeing Research, Swansea University Medical School, Swansea, UK
| | - Alan Watkins
- Health Data Research UK (HDR-UK), Swansea University, Swansea, UK
| | - Damon Berridge
- Health Data Research UK (HDR-UK), Swansea University, Swansea, UK
| | - Andy Clegg
- University of Leeds (Bradford Teaching Hospital), Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK
| | | | | | - Ronan Lyons
- Health Data Research UK (HDR-UK), Swansea University, Swansea, UK
| | - Amy Mizen
- Health Data Research UK (HDR-UK), Swansea University, Swansea, UK
| | - Angharad Walters
- Health Data Research UK (HDR-UK), Swansea University, Swansea, UK
| | - Rhodri Johnson
- Health Data Research UK (HDR-UK), Swansea University, Swansea, UK
| | - Sarah Rodgers
- Health Data Research UK (HDR-UK), Swansea University, Swansea, UK
- Public Health and Policy, University of Liverpool, Liverpool, UK
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16
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Rodgers SE, Bailey R, Johnson R, Berridge D, Poortinga W, Lannon S, Smith R, Lyons RA. Emergency hospital admissions associated with a non-randomised housing intervention meeting national housing quality standards: a longitudinal data linkage study. J Epidemiol Community Health 2018; 72:896-903. [PMID: 29925668 PMCID: PMC6161658 DOI: 10.1136/jech-2017-210370] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 03/27/2018] [Accepted: 05/20/2018] [Indexed: 11/03/2022]
Abstract
BACKGROUND We investigated tenant healthcare utilisation associated with upgrading 8558 council houses to a national quality standard. Homes received multiple internal and external improvements and were analysed using repeated measures of healthcare utilisation. METHODS The primary outcome was emergency hospital admissions for cardiorespiratory conditions and injuries for residents aged 60 years and over. Secondary outcomes included each of the separate conditions, for tenants aged 60 and over, and for all ages. Council home address and intervention records for eight housing cointerventions were anonymously linked to demographic data, hospital admissions and deaths for individuals in a dynamic cohort. Counts of health events were analysed using multilevel regression models to investigate associations between receipt of each housing improvement, adjusting for potential confounding factors and regional trends. RESULTS Residents aged 60 years and over living in homes when improvements were made were associated with up to 39% fewer admissions compared with those living in homes that were not upgraded (incidence rate ratio=0.61, 95% CI 0.53 to 0.72). Reduced admissions were associated with electrical systems, windows and doors, wall insulation, and garden paths. There were small non-significant reductions for the primary outcome associated with upgrading heating, adequate loft insulation, new kitchens and new bathrooms. CONCLUSION Results suggest that hospital admissions can be avoided through improving whole home quality standards. This is the first large-scale longitudinal evaluation of a whole home intervention that has evaluated multiple improvement elements using individual-level objective routine health data.
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Affiliation(s)
- Sarah E Rodgers
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
- Health Data Research-UK, Swansea University, Swansea, UK
| | - Rowena Bailey
- Health Data Research-UK, Swansea University, Swansea, UK
- Data Science Campus, Office for National Statistics, UK
| | - Rhodri Johnson
- Health Data Research-UK, Swansea University, Swansea, UK
| | - Damon Berridge
- Health Data Research-UK, Swansea University, Swansea, UK
| | - Wouter Poortinga
- Welsh School of Architecture, Cardiff University, Cardiff, Wales, UK
| | - Simon Lannon
- Welsh School of Architecture, Cardiff University, Cardiff, Wales, UK
| | - Robert Smith
- School of Geography and Planning, Cardiff University, Cardiff, Wales, UK
| | - Ronan A Lyons
- Health Data Research-UK, Swansea University, Swansea, UK
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17
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Poortinga W, Rodgers SE, Lyons RA, Anderson P, Tweed C, Grey C, Jiang S, Johnson R, Watkins A, Winfield TG. The health impacts of energy performance investments in low-income areas: a mixed-methods approach. PUBLIC HEALTH RESEARCH 2018. [DOI: 10.3310/phr06050] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
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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Affiliation(s)
| | - Sarah E Rodgers
- Farr Institute, College of Medicine, Swansea University, Swansea, UK
| | - Ronan A Lyons
- Farr Institute, College of Medicine, Swansea University, Swansea, UK
| | - Pippa Anderson
- Swansea Centre for Health Economics, College of Human and Health Sciences, Swansea University, Swansea, UK
| | - Chris Tweed
- Welsh School of Architecture, Cardiff University, Cardiff, UK
| | - Charlotte Grey
- Welsh School of Architecture, Cardiff University, Cardiff, UK
| | - Shiyu Jiang
- Welsh School of Architecture, Cardiff University, Cardiff, UK
| | - Rhodri Johnson
- Farr Institute, College of Medicine, Swansea University, Swansea, UK
| | - Alan Watkins
- Farr Institute, College of Medicine, Swansea University, Swansea, UK
| | - Thomas G Winfield
- Swansea Centre for Health Economics, College of Human and Health Sciences, Swansea University, Swansea, UK
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18
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Poortinga W, Jones N, Lannon S, Jenkins H. Social and health outcomes following upgrades to a national housing standard: a multilevel analysis of a five-wave repeated cross-sectional survey. BMC Public Health 2017; 17:927. [PMID: 29197356 PMCID: PMC5712147 DOI: 10.1186/s12889-017-4928-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 11/20/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND While existing research indicates that housing improvements are associated with health improvements, less is known about the wider social and health benefits of meeting national housing standards, as well as those of their specific constituent measures. This study evaluates the impacts of a managed housing upgrade programme through a repeated cross-sectional survey design. METHODS A five-wave repeated cross-sectional survey was conducted over a seven-year period from 2009 to 2016 (n = 2075; n = 2219; n = 2015; n = 1991; and n = 1709, respectively). The study followed a managed upgrade programme designed to meet a national social housing standard over an extended period. The data were analysed from a multilevel perspective to take account of the time-dependent nature of the observations and differences in socio-demographic composition. RESULTS The installation of the majority of individual housing measures (new windows and doors; boilers; kitchens; bathrooms; electrics; loft insulation; and cavity/external wall insulation) were associated with improvements in several social (housing suitability, satisfaction, and quality; thermal comfort and household finances) and health (mental, respiratory and general health) outcomes; and analyses showed relationships between the number of measures installed and the total amount invested on the one hand and the social and health outcomes on the other. There were however a few exceptions. Most notably, the installation of cavity wall insulation was associated with poorer health outcomes, and did not lead to better social outcomes. Also, no association was found between the number of measures installed and respiratory health. CONCLUSIONS The study suggests that substantial housing investments through a managed upgrade programme may result in better social and health outcomes, and that the size of the improvements are proportionate to the number of measures installed and amount invested. However, there may be risks associated with specific measures; and more attention is needed for mechanical ventilation when upgrading energy efficiency of houses through fabric work. In addition to providing new evidence regarding the wider social and health outcomes, the study provides an analytical approach to evaluate upgrade programmes that are delivered over multiple years.
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Affiliation(s)
- Wouter Poortinga
- Welsh School of Architecture, Cardiff University, Bute Building, King Edward VII Avenue, Cardiff, Wales, CF10 3NB, UK. .,School of Psychology, Cardiff University, Tower Building, 70 Park Place, Cardiff, Wales, CF10 3AT, UK.
| | - Nikki Jones
- Welsh School of Architecture, Cardiff University, Bute Building, King Edward VII Avenue, Cardiff, Wales, CF10 3NB, UK
| | - Simon Lannon
- Welsh School of Architecture, Cardiff University, Bute Building, King Edward VII Avenue, Cardiff, Wales, CF10 3NB, UK
| | - Huw Jenkins
- Welsh School of Architecture, Cardiff University, Bute Building, King Edward VII Avenue, Cardiff, Wales, CF10 3NB, UK
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