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

• Published in: BMJ (Online) Vol. 371; p. m4571
• Main Authors: Fyfe, Caroline, Telfar, Lucy, Barnard, Howden-Chapman, Philippa, Douwes, Jeroen
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 29.12.2020; BMJ Publishing Group Ltd
• Subjects: Aged; Asthma; Cardiovascular diseases; Cardiovascular Diseases - epidemiology; Cardiovascular Diseases - prevention & control; Cardiovascular Diseases - therapy; Climate; Cohort analysis; Cold; Coronary artery disease; Datasets; Efficiency, Organizational; Energy efficiency; Environment, Controlled; Female; Heart diseases; Heat; Heating - methods; Heating - statistics & numerical data; Hospitalization; Hospitalization - statistics & numerical data; Housing; Humans; Insulation; Low income groups; Male; Middle Aged; New Zealand - epidemiology; Patient admissions; Population studies; Program Development; Public Health - methods; Public Health - statistics & numerical data; Respiratory diseases; Respiratory Tract Diseases - epidemiology; Respiratory Tract Diseases - prevention & control; Respiratory Tract Diseases - therapy; Retrospective Studies; Subsidies; New Zealand
• ISSN: 1756-1833; 0959-8138; 1756-1833
• DOI: 10.1136/bmj.m4571

AbstractObjectivesTo 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.DesignA quasi-experimental retrospective cohort study using linked datasets to evaluate a national intervention programme.Participants994 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 measureA 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.Results234 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).ConclusionThis 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.