Association between home insulation and hospital admission rates: retrospective cohort study using linked data from a national intervention programme
Open accessAbstract
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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A second quasi-experimental evaluation of the Warm-up NZ Program found that admission rates were significantly lower in the intervention population, with lower hospital admission rates among Pacific peoples and for people over 65 years of age for asthma, cardiovascular disease, and ischemic heart disease, and a 4% reduction in pharmaceuticals for treating respiratory exacerbations in the
“Admission rates were significantly lower in the intervention population. Postintervention, lower hospital admission rates were found among Pacific peoples and for people over 65 years of age for asthma, cardiovascular disease, and ischemic heart disease. There was also a 4% reduction in pharmaceuticals for treating respiratory exacerbations in the intervention group”
From Review of the Impact of Housing Quality on Inequalities in Health and Well-Being (2023) · cites this paper as [45]
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Cites
Meta-analyses of the associations of respiratory health effects with dampness and mold in homes
Fisk, W. J., Lei-Gomez, Q., & Mendell, M. J. (2007) · Indoor Air · doi:10.1111/j.1600-0668.2007.00475.x · Cited by 681 · see citing works
Excess winter mortality in Europe: a cross country analysis identifying key risk factors
Healy, J. (2003) · Journal of Epidemiology & Community Health · doi:10.1136/jech.57.10.784 · Cited by 623 · see citing works
NZDep2013 Index of Deprivation
Atkinson, J., Salmond, C. E., & Crampton, P. (2014) · Cited by 607 · see citing works
Effect of insulating existing houses on health inequality: cluster randomised study in the community
Howden-Chapman, P., Matheson, A., Crane, J., Viggers, H., Cunningham, M., Blakely, T., Cunningham, C., Woodward, A., Saville-Smith, K., O'Dea, D., et al. (2007) · BMJ · doi:10.1136/bmj.39070.573032.80 · Cited by 521 · see citing works
Self-citationSelecting and Improving Quasi-Experimental Designs in Effectiveness and Implementation Research
Handley, M. A., Lyles, C. R., McCulloch, C., & Cattamanchi, A. (2018) · Annual Review of Public Health · doi:10.1146/annurev-publhealth-040617-014128 · Cited by 428 · see citing works
The impact of household energy efficiency measures on health: A meta-analysis
Maidment, C., Jones, C. R., Webb, T. L., Hathway, E. A., & Gilbertson, J. (2013) · Energy Policy · doi:10.1016/j.enpol.2013.10.054 · Cited by 146 · see citing works
Warm homes: Drivers of the demand for heating in the residential sector in New Zealand
Howden‐Chapman, P., Viggers, H. E., Chapman, R., O’Dea, D., Free, S., & O’Sullivan, K. C. (2009) · Energy Policy · doi:10.1016/j.enpol.2008.12.023 · Cited by 138 · see citing works
Self-citationTrends and determinants of excess winter mortality in New Zealand: 1980 to 2000
Davie, G. S., Baker, M. G., Hales, S., & Carlin, J. B. (2007) · BMC Public Health · doi:10.1186/1471-2458-7-263 · Cited by 123 · see citing works
Cold homes, fuel poverty and energy efficiency improvements: A longitudinal focus group approach
Grey, C. N. B., Schmieder-Gaite, T., Jiang, S., Nascimento, C., & Poortinga, W. (2017) · Indoor and Built Environment · doi:10.1177/1420326x17703450 · Cited by 111 · see citing works
A national field survey of house temperatures
Hunt, D. R., & Gidman, M. I. (1982) · Building and Environment · doi:10.1016/0360-1323(82)90048-8 · Cited by 109 · see citing works
Shorter, C., Crane, J., Pierse, N., Barnes, P., Kang, J., Wickens, K., Douwes, J., Stanley, T., Täubel, M., Hyvärinen, A., et al. (2018) · Indoor Air · doi:10.1111/ina.12413 · Cited by 72 · see citing works
Self-citationQuasi-Experimental Design and Methods: Methodological Briefs - Impact Evaluation No. 8Preprint
White, H., & Sabarwal, S. (2014) · RePEc: Research Papers in Economics · Cited by 66 · see citing works
Reduced acute hospitalisation with the healthy housing programme
Jackson, G., Thornley, S., Woolston, J., Papa, D., Bernacchi, A., & Moore, T. (2011) · Journal of Epidemiology & Community Health · doi:10.1136/jech.2009.107441 · Cited by 56 · see citing works
Seasonal patterns of mortality in relation to social factors
Hales, S., Blakely, T. A., Foster, R. H., Baker, M. G., & Howden‐Chapman, P. (2010) · Journal of Epidemiology & Community Health · doi:10.1136/jech.2010.111864 · Cited by 54 · see citing works
Self-citationHousing and respiratory health at older ages
Webb, E. A., Blane, D., & de Vries, R. (2012) · Journal of Epidemiology & Community Health · doi:10.1136/jech-2012-201458 · Cited by 52 · see citing works
Cost benefit analysis of the Warm Up New Zealand: Heat Smart programme
Grimes, A., Denne, T., Howden‐Chapman, P., et al. (2012) · Cited by 47 · see citing works
Self-citationHamilton, I., O'Sullivan, A., Huebner, G. M., Oreszczyn, T., Shipworth, D., Summerfield, A. J., & Davies, M. (2017) · Energy and Buildings · doi:10.1016/j.enbuild.2017.02.014 · Cited by 46 · see citing works
Improving health and energy efficiency through community-based housing interventions
Howden‐Chapman, P., Crane, J., Chapman, R., & Fougere, G. (2011) · International Journal of Public Health · doi:10.1007/s00038-011-0287-z · Cited by 44 · see citing works
Self-citationHEYMAN, B., Harrington, B., Merleau-Ponty, N., Stockton, H., RITCHIE, N., & Allan, T. F. (2005) · Housing Studies · doi:10.1080/02673030500114656 · Cited by 40 · see citing works
Preval, N., Keall, M., Telfar-Barnard, L., Grimes, A., & Howden‐Chapman, P. (2017) · BMJ Open · doi:10.1136/bmjopen-2017-018079 · Cited by 39 · see citing works
Self-citationCan housing improvements cure or prevent the onset of health conditions over time in deprived areas?
Curl, A., & Kearns, A. (2015) · BMC Public Health · doi:10.1186/s12889-015-2524-5 · Cited by 32 · see citing works
Anderson, P., Craig, E., Jackson, G., et al. (2012) · PubMed · Cited by 31 · see citing works
Full-scale water penetration tests on twelve cavity fills—Part I. Nine retrofit fills
Newman, A. J., Whiteside, D., Kloss, P. B., et al. (1982) · Building and Environment · doi:10.1016/0360-1323(82)90038-5 · Cited by 15 · see citing works
Novel use of three administrative datasets to establish a cohort for environmental health research
Telfar-Barnard, L., Baker, M. G., Hales, S., et al. (2015) · BMC Public Health · doi:10.1186/s12889-015-1580-1 · Cited by 10 · see citing works
Government failure and success: A trans-Tasman comparison of two insulation subsidy schemes
Preval, N., Ombler, J., Grimes, A., Keall, M., & Howden‐Chapman, P. (2019) · Agenda - A Journal of Policy Analysis and Reform · doi:10.22459/ag.26.01.2019.03 · Cited by 3 · see citing works
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Flagged first, then by citations
Research works printed but not linked: 2
- [23]Baker M, McDonald A, Zhang J, Howden-Chapman P. Infectious diseases attributed to household crowding in New Zealand: A systematic review and burden of disease estimate. He Kainga Oranga, University of Otago, Wellington. 2013.
- [31]Preval N. Evaluation of Public Health Interventions (unpublished doctoral dissertation). He Kainga Oranga/Housing and Health Research Programme, Wellington School of Medicine, University of Otago, 2015.
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Review of the Impact of Housing Quality on Inequalities in Health and Well-Being
Howden-Chapman, P., Bennett, J., Edwards, R., Jacobs, D., Nathan, K., & Ormandy, D. (2023) · Annual Review of Public Health · doi:10.1146/annurev-publhealth-071521-111836 · Cited by 153 · see citing works
Self-citationBroadbent, P., Thomson, R., Kopasker, D., McCartney, G., Meier, P., Richiardi, M., McKee, M., & Katikireddi, S. V. (2023) · The Lancet Regional Health - Europe · doi:10.1016/j.lanepe.2023.100585 · Cited by 121 · see citing works
Retrofitting home insulation reduces incidence and severity of chronic respiratory disease
Fyfe, C., Barnard, L. T., Douwes, J., Howden‐Chapman, P., & Crane, J. (2022) · Indoor Air · doi:10.1111/ina.13101 · Cited by 22 · see citing works
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- Authors
- Fyfe, C., Telfar, L., Barnard, Howden-Chapman, P., & Douwes, J.
- Affiliations
- University of Otago (NZ)
- Massey University (NZ)
- Corresponding author
- Fyfe, Caroline
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 2020-12-29
- Volume
- 371
- Pages
- m4571
- ISSN
- 1756-1833 (ISSN-L)
- PMC
- PMC7770561
- OpenAlex
- W3116476642
- Cited by
- 42
- References
- 25
- Citations by year
- 2026: 5 · 2025: 10 · 2024: 4 · 2023: 6 · 2022: 10 · 2021: 6 · 2020: 1
- FWCI
- 1.42
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- BMJ (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion, other-oa)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Massey Research Online (Massey University) (submittedVersion, cc-by-nc)
- HighWire Press Open Archive (submittedVersion)
- Funders
- University of Otago
- Imperial College London
- Massey University
- Topics
- Physical Sciences › Environmental Science › Pollution › Energy and Environment Impacts
- Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Climate Change and Health Impacts
- Physical Sciences › Engineering › Building and Construction › Building Energy and Comfort Optimization
- Keywords
- home insulation, energy retrofit, respiratory diseases, asthma, cardiovascular disease, ischemic heart disease, Pacific Islanders, older adults
- MeSH terms
- Aged, Cardiovascular Diseases, Environment, Controlled, Female, Heating, Hospitalization, Housing, Humans, Male, Middle Aged, New Zealand, Public Health, Respiratory Tract Diseases, Retrospective Studies, Program Development, Efficiency, Organizational
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