The effect of the Winter Fuel Payment on household temperature and health: a regression discontinuity design study

The impact of cold spells and heat waves frequencies on the prevalence and incidence of stroke in middle-to-elderly age population in China: evidence from the China Health and Retirement Longitudinal Study (CHARLS)

Stroke, a key cardiovascular disease, is impacted by cold spells and heat waves. However, limited sample size and unclear impact on the aging population's prevalence and incidence remain concerns. We aim to explore the association between cold spells and heat waves frequency and stroke in middle-aged and elderly people in China. Utilizing data from the China Health and Retirement Longitudinal Study (CHARLS), this study conducted cross-sectional (16,766 participants aged 45 and above in 2011) and longitudinal analyses (tracked 15,215 stroke-free participants from 2011 to 2018). Cold spells and heat waves are defined by temperature thresholds and duration for a given community. The stroke cases were identified through self-reports. Logistic regression, Cox proportional-hazards model and time-varying Cox proportional hazards regression model were employed in our analysis. In the cross-sectional study, 469 (2.8%) participants suffered stroke. Every 1 event increased in cold spells frequency (OR: 1.205, 95% CI: 1.067,1.361) and heat waves frequency (OR: 1.087, 95% CI: 1.017,1.162) was positively associated with stroke prevalence. In the cohort study, 1,028 (6.8%) developed stroke during an average follow-up of 6.3 years. We observed consistent adverse effects of cold spells on stroke incidence (HR: 1.149, 95% CI: 1.062, 1.243), whereas heat waves showed no significant association. Considering exposure changes during follow-up, both cold spells and heat waves significantly increased stroke incidence. Subgroup analyses showed a significant interaction between heat waves and geographic location, which indicated northern residents exhibited higher risks. Our study suggests that cold spells elevate stroke risk among middle-aged and older Chinese adults. Meantime, the impact of heat waves on stroke incidence is also worth noting for northern residents. This finding provides evidence of temperature fluctuation's impact on this cardiovascular event in the nationwide population, suggesting temperature-control optimization could be an effective disease-control measure.

The Mental Health Impacts of Fuel Poverty: A Global Scoping Review

Objectives

Fuel poverty, defined in this study as a household's inability to meet basic energy needs, presents a significant challenge. We aimed to map research on the impact of fuel poverty on mental health.

Methods

We searched peer review and grey literature repositories. Studies were considered eligible if they focused on both fuel poverty and mental health.

Results

47 studies were included. 64% were published in the last 3 years. 43% focused on the UK sub-geography, with the next most common being Spain (17%) and China (13%). 55% had a quantitative study design. Conceptualisation and operationalisation of fuel poverty varied across studies and contexts. 58% focused on specific vulnerable populations. 46 studies reported evidence of a detrimental association between fuel poverty and mental health. We broadly summarise the role of fuel poverty on mental health under four headings: economic, social, behavioural and environmental.

Conclusion

We highlight a need for clear and explicit conceptualisation of fuel poverty, in conjunction with consideration of pathways connecting fuel poverty to mental health, to advance the field and facilitate research which can improve population health.

Interventions for cold homes: a rapid review of the health impacts

BACKGROUND

Cold homes are associated with an increased risk of adverse health outcomes for older people. To mitigate this risk, homes need to be heated to an appropriate temperature. This review aims to identify interventions designed to improve heating and temperatures within homes and summarize its impact on health, health service utilization and cost effectiveness.

METHODS

A rapid review was conducted. Studies assessing the effects of structural, financial, or behavioural interventions designed to improve home temperatures of residents aged 18+ years were eligible. Searches were carried out in four databases. A search for grey literature, and backward and forward citation searching were performed. Data were summarized in a narrative synthesis and mapped using EPPI-Reviewer and EPPI-Mapper software.

RESULTS

Eighteen studies reported across 19 publications were included. Structural interventions were associated with better mental health and quality of life, a reduction in health service utilization, and improvements in satisfaction with internal home temperature, social interactions and financial difficulties. The impact on physical health outcomes varied by age, gender and long-term conditions. Evidence about the impact of behavioural interventions was inconsistent.

CONCLUSION

Structural improvements to increase home temperatures may offer the potential to improve some aspects of health. However, the impact on physical health, including which groups are most likely to benefit, is unclear. Key gaps include the lack of evidence about the impact of financial interventions, and the impact of all types of interventions, on quality of life, mortality and costs.

Effectiveness of financial support interventions to reduce adverse health outcomes among households in fuel poverty in the United Kingdom

Objectives

This systematic review intended to assess the effectiveness of financial support interventions for household fuel poverty in the UK in terms of reducing adverse impacts on the health and wellbeing of recipients.

Methods

Bibliographic databases and grey literature sources were searched from the UK for studies that evaluated the health and wellbeing of participants following financial support to optimize indoor heating. Two independent reviewers carried out screening, data extraction and quality assessment of the articles. The outcomes included direct health-related outcomes such as Excess Winter Mortality (EWM), physical/mental health, health services utilization, well-being, and quality of life. Indirect health related outcomes included temperature, condensation/mould/dampness (CMD), fuel efficiency/expenditure and satisfaction with warmth. Due to the heterogeneity of interventions and outcomes, a narrative synthesis of the data was carried out.

Results

Twenty studies were included in the review: randomized controlled trials (n = 1), before and after evaluation of interventions (n = 14), ecological studies (n = 1) and modelling studies (n = 4). Sixteen studies assessed impacts of home energy efficiency improvements (HEEI) only, three studies assessed impacts of Winter Fuel Payment (WFP) only while one study assessed impacts of both HEEI and WFP. HEEI studies reported improved indoor temperatures (n = 4), reduced CMD (n = 6), reduced fuel expenditure (n = 4), improved thermal comfort (n = 7), improvements in general health (n = 4), increased wellbeing (n = 4), improved physical health (n = 2), improved mental health (n = 3), reduced new health events (n = 1) and improved existing medical conditions (n = 2). Two HEEI were reported cost effective with added years to life. During modelling studies WFP was found to significantly reduce EWM (n = 2) and fibrinogen levels (n = 1).

Conclusions

Most financial support interventions included in this review demonstrated positive impacts on health and wellbeing of recipients supporting their implementation with robust evaluations to better understand the cost effectiveness and long-term impacts in the future. Implementation of these interventions will require cross-sector collaborations, with consideration of which populations are most likely to benefit.

Cold homes and mental health harm: Evidence from the UK Household Longitudinal Study

Cold homes are associated with a range of serious health conditions as well as excess winter mortality. Despite a comparatively mild climate cold homes are a significant problem in the UK, with a recent estimate finding that over one-quarter of low-income households had been unable to adequately heat their home in winter 2022. The magnitude of cold housing in a country that benefits from a mild climate indicates indifference towards, or acceptance of, a significant minority of people living in inadequate conditions on the part of policy makers. Cold homes are therefore a source of social harm. Recent changes to the household energy price cap, the rising cost of living, the ongoing effects of the benefit cap, and below inflation uprating to social security benefits is likely to greatly exacerbate this issue. In this research we use data from the UK Household Longitudinal Study to explore whether living in a cold home causes mental health harm. We control for mental distress and housing temperature on entry to the survey in order to account for the potentially bi-directional relationship. Multilevel discrete-time event history models show that the transition into living in a home that is not suitably warm is associated with nearly double the odds of experiencing severe mental distress for those who had no mental distress at the beginning of the survey; and over three times the odds of severe mental distress for those previously on the borderline of severe mental distress. These results show the significant costs of failing to ensure that people are able to live in homes in which they are able to live comfortably by even the most basic standards. These costs will be felt not just individually, but also more broadly in terms of increased health spending and reduced working.