{
  "abstract": "Background There is a strong policy drive to improve energy efficiency in UK homes, but evidence of associated respiratory health effects is conflicting. We aimed to investigate associations between different measures of energy efficiency and common long-term respiratory diseases using the Wales-wide Secure Anonymised Information Linkage (SAIL) Databank.Methods We performed a retrospective observational study using SAIL Databank health data. Energy Performance Certificates (EPCs) were linked to GP, demographic, mortality, and 2021 Census data for the first time, examined descriptively and cleaned. Population: All adults registered as usually resident in Wales, registered at a GP providing data to SAIL, and with address-linked EPC and 2021 Census data for their address as of 21/3/2021. Exposures: Wall insulation type (cavity wall insulation, CWI, or non-cavity wall insulation, NCWI, relative to uninsulated) and aggregate household-level energy efficiency (EPC rating). Outcomes: First GP-coded diagnosis of asthma or COPD (separately). Covariates: Age, sex, education, socio-economic classification, occupancy, building age and size, main fuel, tenure type, urban/rural, area deprivation quintile. Analyses: Univariable and multivariate adjusted survival analyses, using Cox regression, was conducted separately for asthma and for COPD. This covered the periods in which GP and EPC data were valid for the address that each individual resided at on 21/3/2021; restricted to individuals with no recorded asthma/COPD prior and with complete covariates.Results 431,468 adults were included in the asthma and 563,722 in COPD analyses. Unadjusted longitudinal analysis showed an association with asthma diagnosis (HR 1.06; 95%C.I.1.03–1.10 for CWI and HR 1.05; 95% C.I.0.99–1.12 for NCWI). Stronger associations were observed with COPD in unadjusted analyses (HR 1.17; 95%C.I. 1.12–1.23 for cavity wall; 1.24; 95%C.I. 1.13–1.36 for NCWI). However, in fully-adjusted longitudinal analysis, significant associations were not observed with asthma (HR 1.04, 95%C.I.0.99–1.09 for CWI; HR 1.00, 95%C.I. 0.92–1.08 for NCWI), or COPD (adjusted HRs 1.03; 95%C.I. 0.97–1.10 for CWI and 1.04; 95%C.I. 0.94–1.15 for NCWI). The analysis did not find significant unadjusted or adjusted associations with different aggregate energy efficiency categories, for asthma or COPD.Conclusion Our analysis of a large, representative cohort from Wales, adjusted for multiple covariates, does not support the hypothesis that wall insulation is associated with better respiratory health. Limitations include the unrepresentative EPC data used. This should be examined in other large health datasets, alongside routine health outcomes evaluation when energy-efficiency measures are implemented.",
  "authors": [
    {
      "affiliations": [
        "Research Department of Primary Care and Population Health, University College London, London, UK"
      ],
      "name": "Isobel Braithwaite"
    },
    {
      "affiliations": [
        "Swansea University Medical School, Swansea University, Swansea, UK"
      ],
      "name": "Rhodri Johnson"
    },
    {
      "affiliations": [
        "Institute for Environmental Design, Bartlett Sch. of Env, Energy andResources, University College London, London, UK"
      ],
      "name": "Anna Mavrogianni"
    },
    {
      "affiliations": [
        "MRC Unit for Lifelong Health and Ageing, Institute of Cardiovascular Science, University College London, London, UK"
      ],
      "name": "Michalis Katsoulis"
    },
    {
      "affiliations": [
        "Institute of Health Informatics, University College London, London, UK"
      ],
      "name": "Spiros Denaxas"
    },
    {
      "affiliations": [
        "Research Department of Primary Care and Population Health, University College London, London, UK"
      ],
      "name": "Jessica Sheringham"
    }
  ],
  "title": "P34 Longitudinal associations between housing energy efficiency measures, asthma and chronic obstructive pulmonary disease (COPD) risk in a large, linked housing and health dataset in Wales",
  "uid": "00a234b0-5982-55db-baea-b130c5da92ff"
}