title: Housing interventions and health: Quantifying the impact of indoor particles on mortality and morbidity with disease recovery.
abstract: Housing interventions for energy efficiency and greenhouse gas emission reduction have the potential to reduce exposure to indoor air pollution if they are implemented correctly. This work assessed the health impacts of home energy efficiency measures in England and Wales resulting in a reduction in average indoor PM2.5 exposures of 3 μg m(-3). The assessment was performed using a new multistate life table model which allows transition into and between multiple morbid states, including recovery to disease-free status and relapse, with transition rates informed by age- and cause-specific disease prevalence, incidence and mortality data. Such models have not previously included disease recovery. The results demonstrate that incorporation of recovery in the model is necessary for conditions such as asthma which have high incidence in early life but likelihood of recovery in adulthood. The impact assessment of the home energy efficiency intervention showed that the reduction in PM2.5 exposure would be associated with substantial benefits for mortality and morbidity from asthma, coronary heart disease and lung cancer. The overall impact would be an increase in life expectancy of two to three months and approximately 13 million QALYs gained over the 90 year follow-up period. Substantial quality-of-life benefits were also observed, with a decrease in asthma over all age groups and larger benefits due to reduced coronary heart disease and lung cancer, particularly in older age groups. The multistate model with recovery provides important additional information for assessing the impact on health of environmental policies and interventions compared with mortality-only life tables, allowing more realistic representation of diseases with substantial non-mortality burdens.
authors.affiliation: Department of Social & Environmental Health Research, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK. Electronic address: james.milner@lshtm.ac.uk.
authors.forename: James
authors.initials: J
authors.lastname: Milner
authors.affiliation: Department of Social & Environmental Health Research, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK. Electronic address: zaid.chalabi@lshtm.ac.uk.
authors.forename: Zaid
authors.initials: Z
authors.lastname: Chalabi
authors.affiliation: Department of Social & Environmental Health Research, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK; Centre for Radiation, Chemical & Environmental Hazards, Public Health England, Harwell Campus, OX11 0RQ, UK. Electronic address: sotiris.vardoulakis@phe.gov.uk.
authors.forename: Sotiris
authors.initials: S
authors.lastname: Vardoulakis
authors.affiliation: Department of Social & Environmental Health Research, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK. Electronic address: paul.wilkinson@lshtm.ac.uk.
authors.forename: Paul
authors.initials: P
authors.lastname: Wilkinson
mesh_terms: D000393:Air Pollutants / Q000032:analysis*; D016902:Air Pollution, Indoor / Q000032:analysis*; D001249:Asthma / Q000453:epidemiology; D003246:Conservation of Energy Resources; D004739:England / Q000453:epidemiology; D006798:Housing; D006801:Humans; D015994:Incidence; D008017:Life Expectancy; D015993:Life Tables; D009017:Morbidity; D052638:Particulate Matter / Q000032:analysis*; D015995:Prevalence; D014852:Wales / Q000453:epidemiology
chemical_list: D000393:Air Pollutants; D052638:Particulate Matter
keywords: Disease recovery; Health impact assessment; Indoor air pollution; Particulate matter; Quality of life