{
  "abstract": "Background Cold weather remains a serious health threat in the UK and elsewhere, particularly for older adults. The Winter Fuel Payment has been a key government strategy to mitigate health risks linked to cold homes in the UK, but recent policy shifts have raised questions about whether income-based eligibility criteria effectively identify those most at risk.Methods We analysed cold-related mortality in adults aged ≥75 across 324 local authority districts in England (2007–2019) using distributed lag non-linear models in a spatial Bayesian framework. Multivariate meta-regression was used to evaluate modification of cold effects by deprivation, income-based pension credit uptake, home energy efficiency and fuel poverty.Results Areas in the highest quartile of fuel poverty had significantly greater cold-related mortality risk than those in the lowest quartile, with a 15.3% versus 13.1% increase in mortality risk at the first compared with the 50th percentile of wintertime temperature, ie, an absolute difference of 2.2% (p<0.001). This effect was stronger than the corresponding differences for energy efficiency (1.7%, p=0.04), income as indicated by pension credit uptake (0.6%, p=0.39) and deprivation-based measures, for which differences were minimal. Overall, an estimated 17% of cold-related deaths among people aged ≥75 were attributable to fuel poverty.Conclusion Fuel poverty, an indicator designed to capture both low-income and housing energy efficiency, is a stronger predictor of cold-related mortality than income (as indicated by pension credit update) or deprivation-based indicators alone. Winter energy support schemes should consider fuel poverty metrics in their targeting to more effectively reduce health risks associated with cold homes and improve equity.",
  "authors": [
    {
      "affiliations": [
        "London School of Hygiene & Tropical Medicine, London, UK"
      ],
      "name": "Kai Wan"
    },
    {
      "affiliations": [
        "Department of Civil Engineering, Tampere University, Tampere, Pirkanmaa, Finland"
      ],
      "name": "Jonathon Taylor"
    },
    {
      "affiliations": [
        "ISGlobal, Barcelona, Spain",
        "University of Bern Institute of Social and Preventive Medicine, Bern, BE, Switzerland",
        "University of Bern Oeschger Centre for Climate Change Research, Bern, BE, Switzerland"
      ],
      "name": "Marcos Quijal-Zamorano"
    },
    {
      "affiliations": [
        "ISGlobal, Barcelona, Spain"
      ],
      "name": "Joan Ballester"
    },
    {
      "affiliations": [
        "London School of Hygiene & Tropical Medicine, London, UK"
      ],
      "name": "Shakoor Hajat"
    }
  ],
  "title": "Eligibility criteria for the UK Winter Fuel Payment: are we targeting the right people?",
  "uid": "f8d5730e-6186-5773-9ee3-1c3d25bc48b6"
}