title: A measure for quantifying the impact of housing quality on respiratory health: a cross-sectional study.
abstract: BACKGROUND
  Damp and mould in homes have been established as risk factors for respiratory health. There is a need for a relatively straightforward assessment of the home that quantifies this risk.
  
  
  METHODS
  Using data from 891 New Zealand houses, the utility of a Respiratory Hazard Index quantifying key attributes related to damp and mould was tested by studying its associations with self-reported respiratory symptoms.
  
  
  RESULTS
  A dose-response relationship was found whereby each unit increase in the Respiratory Hazard Index was associated with an 11% increase in the odds of at least one episode of wheezing/whistling in the chest over the last 12 months (relative odds of 1.11 with a 95% CI 1.04%-1.20%). An 11% increase in the odds of an asthma attack over the last 12 months was estimated (relative odds of 1.11 with a 95% CI 1.01%-1.22%). These estimates were adjusted for household crowding levels, age, sex and smoking status. There was suggestive evidence of more steeply increasing odds of respiratory symptoms with increasing levels of the Respiratory Hazard Index for children aged under 7. In the worst performing houses according to the Index, a 33% reduction in the number of people experiencing respiratory symptoms (relative risk 0.67 with 95% CI 0.53 to 0.85) could be expected if people were housed in the best performing houses.
  
  
  CONCLUSIONS
  This study showed that increased evidence of housing conditions supporting dampness and mould was associated with increased odds of respiratory symptoms. A valid housing assessment tool can provide a rational basis for investment in improved housing quality to improve respiratory health.
authors.affiliation: He Kainga Oranga/Housing and Health Research Programme, Department of Public Health, University of Otago, PO Box 7343, Wellington South, New Zealand. Michael.Keall@otago.ac.nz
authors.forename: Michael D
authors.initials: MD
authors.lastname: Keall
authors.forename: Julian
authors.initials: J
authors.lastname: Crane
authors.forename: Michael G
authors.initials: MG
authors.lastname: Baker
authors.forename: Kristin
authors.initials: K
authors.lastname: Wickens
authors.forename: Philippa
authors.initials: P
authors.lastname: Howden-Chapman
authors.forename: Malcolm
authors.initials: M
authors.lastname: Cunningham
mesh_terms: D000293:Adolescent; D000328:Adult; D001249:Asthma / Q000453:epidemiology / Q000209:etiology*; D002648:Child; D003430:Cross-Sectional Studies; D004305:Dose-Response Relationship, Drug; D005658:Fungi / Q000254:growth & development; D006798:Housing; D006801:Humans; D006813:Humidity; D007223:Infant; D016015:Logistic Models; D008875:Middle Aged; D009520:New Zealand / Q000453:epidemiology; D016017:Odds Ratio; D009812:Odorants / Q000032:analysis; D012135:Respiratory Sounds / Q000209:etiology*; D012306:Risk; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012621:Seasons