Rhodri Johnson

Risk factors associated with unintentional house fire incidents, injuries and deaths in high-income countries: a systematic review

Objective To identify the distinguishing risk factors associated with unintentional house fire incidents, injuries and deaths. Study design Systematic review. Methods A range of bibliographical databases and grey literature were searched from their earliest records to January 2016. To ensure the magnitude of risk could be quantified, only those study types which contained a control group, and undertook appropriate statistical analyses were included. A best evidence synthesis was conducted instead of a meta-analysis due to study heterogeneity. Results Eleven studies investigating a variety of risk factors and outcomes were identified. Studies ranged from medium to low quality with no high quality studies identified. Characteristics commonly associated with increased risk of house fire incidents, injuries and fatalities included: higher numbers of residents, male, children under the age of 5 years, non-working households, smoking, low income, non-privately owned properties, apartments and buildings in poor condition. Several risk factors were only associated with one outcome (eg, living alone was only associated with increased risk of injurious fires), and households with older residents were at increased risk of injurious fires, but significantly less likely to experience a house fire in the first place. Conclusions This best evidence synthesis indicates that several resident and property characteristics are associated with risk of experiencing house fire incidents, injuries or death. These findings should be considered by the Fire and Rescue Services and others with a role in fire prevention. Future research should adopt robust, standardised study designs to permit meta-analyses and enable stronger conclusions to be drawn.

Neighborhood Quality and Attachment: Validation of the Revised Residential Environment Assessment Tool

Various studies have shown that neighborhood quality is linked to neighborhood attachment and satisfaction. However, most have relied upon residents’ own perceptions rather than independent observations of the neighborhood environment. This study examines the reliability and validity of the revised Residential Environment Assessment Tool (REAT 2.0), an audit instrument covering both public and private spaces of the neighborhood environment. The research shows that REAT 2.0 is a reliable, easy-to-use instrument and that most underlying constructs can be validated against residents’ own neighborhood perceptions. The convergent validity of the instrument, which was tested against digital map data, can be improved for a number of miscellaneous urban form items. The research further found that neighborhood attachment was significantly associated with the overall REAT 2.0 score. This association can mainly be attributed to the property-level neighborhood quality and natural elements components. The research demonstrates the importance of private spaces in the outlook of the neighborhood environment.

Emergency hospital admissions associated with a non-randomised housing intervention meeting national housing quality standards: a longitudinal data linkage study

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.

Creating individual level air pollution exposures in an anonymised data safe haven: a platform for evaluating impact on educational attainment

Abstract Introduction There is a lack of evidence on the adverse effects of air pollution on cognition for people with air quality-related health conditions. We propose that educational attainment, as a proxy for cognition, may increase with improved air quality. This study will explore whether asthma and seasonal allergic rhinitis, when exacerbated by acute exposure to air pollution, is associated with educational attainment. Objective To describe the preparation of individual and household-level linked environmental and health data for analysis within an anonymised safe haven. Also to introduce our statistical analysis plan for our study: COgnition, Respiratory Tract illness and Effects of eXposure (CORTEX). Methods We imported daily air pollution and aeroallergen data, and individual level education data into the SAIL databank, an anonymised safe haven for person-based records. We linked individual-level education, socioeconomic and health data to air quality data for home and school locations, creating tailored exposures for individuals across a city. We developed daily exposure data for all pupils in repeated cross sectional exam cohorts (2009-2015). Conclusion We have used the SAIL databank, an innovative, data safe haven to create individual-level exposures to air pollution and pollen for multiple daily home and school locations. The analysis platform will allow us to evaluate retrospectively the impact of air quality on attainment for multiple cross-sectional cohorts of pupils. Our methods will allow us to distinguish between the pollution impacts on educational attainment for pupils with and without respiratory health conditions. The results from this study will further our understanding of the effects of air quality and respiratory-related health conditions on cognition. Highlights This city-wide study includes longitudinal routinely-recorded educational attainment data for all pupils taking exams over seven years; High spatial resolution air pollution data were linked within a privacy protected databank to obtain individual exposure at multiple daily locations; This study will use health data linked at the individual level to explore associations between air pollution, related morbidity, and educational attainment.

OP56 Effects of national housing quality standards on hospital emergency admissions: a quasi-experiment using data linkage

Background National housing quality standards are being applied throughout the UK. A housing improvement programme was delivered through a local authority to bring nearly 9000 homes up to the Welsh Housing Quality Standard (WHQS). Homes received multiple elements, including new kitchens, bathrooms, windows and doors, insulation, and heating and electrical systems, through an eight-year rolling work programme. The study aimed to determine the impacts of the different housing improvements on hospital emergency admissions for all residents. Methods Intervention homes, council homes that received at least one element of work, were data linked to individual health records of residents. Counts of admissions relating to respiratory and cardiovascular conditions, and falls and burns, were obtained retrospectively for each individual in a dynamic housing cohort (January 2005–March 2015). The intervention cohort criterion was for someone to have lived in any one of the intervention homes for at least three months within the intervention period. Counts were captured for up to 123 consecutive months for 32 009 individuals in the intervention cohort and analysed using a multilevel approach to account for repeated observations for individuals, nested within geographic areas. Negative Binomial regression models were constructed to determine the effect for each element of work on emergency admissions for those people living in homes in receipt of the intervention element, compared to those living in homes that did not meet quality standards at that time. We adjusted for background trends in the regional general population, as well as for other confounding factors. Results People of all ages had 34% fewer admissions for cardiovascular and respiratory conditions, and fall and burn injuries while living in homes when the electrical systems were upgraded, compared to the reference group (IRR=0.66, 95% CI 0.58–0.76). Reduced admissions were also found for new windows and doors (IRR=0.78, 0.70–0.87), wall insulation (IRR=0.80, 0.73–0.87) and garden paths (IRR=0.81, 0.73–0.90). There were no associations of change in emergency admissions with upgrading heating (IRR=0.92, 0.85–1.01), loft insulation, (IRR=1.02, 0.93–1.13), kitchens (IRR=1.01, 0.87–1.18), or bathrooms (IRR=0.99, 0.87–1.13). Conclusion Improving housing to national standards reduces the number of emergency admissions to hospital for residents. Strengths of the data linkage approach included the retrospective collection of complete baseline and follow up using routine data for a long-term intervention, and large scale regional adjustment.

Effects of national housing quality standards on hospital emergency admissions: a quasi-experiment using data-linkage

Abstract Background National housing quality standards are now being applied throughout the UK. The Welsh Government has introduced the Welsh Housing Quality Standards. A housing improvement programme in Wales has been delivered through one local authority to bring 9500 homes up to standard. Homes received multiple elements, including new kitchens, bathrooms, windows and doors, boilers, insulation, and wiring, through an 8 year rolling work programme. The study aimed to determine the impacts of the different housing improvements on hospital emergency admissions for residents over 60 years of age. Methods Intervention homes (council homes that received at least one element of work) were data linked to individual health records of residents. Counts of admissions for respiratory and cardiovascular conditions, and for falls and burns, were obtained retrospectively for each individual in a dynamic housing cohort (Jan 1, 2005, to March 31, 2015). The criterion for the intervention cohort was for someone to have lived in any one of the 9500 intervention homes for at least 3 months within the intervention period. Counts were captured for up to 123 consecutive months for 7054 individuals in the intervention cohort and analysed in a multilevel approach to account for repeated observations for individuals, nested within geographical areas. Negative binomial regression models were constructed to determine the effect on emergency admissions for those living in homes compliant for each element of work compared with those living in homes that were non-compliant at that time. We adjusted for background trends in the regional general population, and for other confounding factors. Findings For residents 60 years old and over there was a reduction in admissions for people with compliant boilers (rate ratio 0·71, 95% CI 0·67–0·76), loft insulation (0·87, 0·80–0·95), wall insulation (0·74, 0·69–0·80), and windows and doors (0·56, 0·52–0·61) compared with those living in homes that were non-compliant for those work elements. Interpretation Improving housing to national standards reduces the number of emergency admissions to hospital for older residents. Strengths of the data-linkage approach included the retrospective collection of complete baseline and follow-up data using routine data for a long-term intervention, and large scale regional adjustment. Funding National Institute for Health Research (NIHR) Public Health Research programme (project number 09/3006/02).

Short-term health and social impacts of energy-efficiency investments in low-income communities: a controlled field study

Abstract Background During 2012–15, £45 million was invested to improve the energy-efficiency of 4800 houses in low-income areas across Wales. Houses received measures such as external wall insulation, new windows and doors, upgrades to the heating system, and connection to the gas network. This study aimed to establish the short-term health and social impacts of these investments. Methods A quasi-experimental field study with a controlled, before and after design was conducted (364 individuals in improved houses [intervention], 418 in houses with no improvements [control]). Any adult living in 24 selected intervention areas and matched control areas (n=23) was eligible for inclusion. Self-completed questionnaires, administered via a drop-off-and-collect method, were collected in the winter months (December to February) before and after installation of the energy efficiency measures. Health outcomes were mental health composite scale (MCS) and physical health composite scale (PCS) scores of the SF-12v2, SF-6D utility scores derived from the SF-12v2, self-reported respiratory symptoms, and subjective wellbeing. Social outcomes were financial difficulties and stress, food security, thermal comfort, housing conditions, and social isolation. The study used measures validated in previous research. Linear, ordered multinomial, and logistic multilevel models were constructed with measurement occasions nested within individuals. Findings After controlling for sex, age, housing benefit, household income, and smoking status, we found that investments were not associated with improvements in MCS (B=0·00, 95% CI −1·60 to 1·60) or PCS (0·98, −0·34 to 2·28) scores, SF-6D utilities (−0·01, −0·04 to 0·02), or self-reported respiratory symptoms (−0·14, −0·54 to 0·26). However, people who received energy-efficiency measures reported improved subjective wellbeing compared with controls (B=0·38, 95% CI 0·12 to 0·65), and fewer financial difficulties (−0·15, −0·25 to −0·05); they reported higher thermal comfort (odds ratio 3·83, 95% CI 2·40 to 5·90), higher satisfaction with the improvement of their homes (3·87, 2·51 to 5·96), and less reluctance to invite friends or family to their homes (0·32, 0·13 to 0·77). Interpretation Although there is no evidence that energy-efficiency investments provide physical health benefits in the short term, they improve social and economic conditions that are conducive to better health. Longer term studies are needed to establish the health impacts of energy-efficiency investments. Funding National Institute for Health Research (NIHR) Public Health Research (PHR) programme (project number 11/3020/05).

843 Risk factors for unintentional house fire incidents, injuries and deaths: a systematic review

Background Unintentional house fires appear to be reducing but remain a serious public health concern, disproportionately affecting certain groups in population. To ensure preventative measures reach those at greatest risk, it is vital that risk factors for unintentional fires are identified; particularly in light of recent funding cuts in many Fire Services across high-income countries. However, the last review to be conducted in this area was undertaken over 15 years ago. Methods To synthesise the evidence on risk factors for unintentional house fires, a range of bibliographic databases and grey literature were searched until October 2015. Key journals and reference lists were also hand-searched. To ensure the magnitude of risk could be quantified for each factor, only those studies that contained a comparison group, and undertook appropriate statistical analyses were included. A best evidence synthesis was undertaken instead of a meta-analysis due to study heterogeneity. Results This review identified 12 studies that investigated a variety of potential risk factors and outcomes that fulfilled the inclusion criteria. None of the identified studies were deemed high quality, but the available evidence suggests the following factors may be associated with fire risk: age, gender, socio-economic status, race/ethnicity, disability, household ownership, household composition, property characteristics, smoking, alcohol/drug use, fire safety practices and marital status. It also appears that whilst older and disabled residents are more likely to suffer an injury or fatality in the event of a fire; they are less likely to ignite a fire in the first instance. Conclusions There is a surprising paucity of high quality studies examining risk factors for house fire incidents, injuries and deaths. Further high quality studies, adopting standardised methods are required to permit synthesis, and to develop a firmer understanding of unintentional house fire risk factors.