Association between home insulation and hospital admission rates: retrospective cohort study using linked data from a national intervention programme [家庭房屋装隔热材料与医院入院率之间的关系：使用国家干预计划中的相关数据进行的回顾性队列研究]

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BMJ 2020; 371 doi: https://doi.org/10.1136/bmj.m4571 (Published 29 December 2020)
Cite this as: BMJ 2020;371:m4571

Authors
Caroline Fyfe, Lucy Telfar, Barnard, Philippa Howden-Chapman, Jeroen Douwes

Abstract
Objectives To investigate whether retrofitting insulation into homes can reduce cold associated hospital admission rates among residents and to identify whether the effect varies between different groups within the population and by type of insulation.

Design A quasi-experimental retrospective cohort study using linked datasets to evaluate a national intervention programme.

Participants 994 317 residents of 204 405 houses who received an insulation subsidy through the Energy Efficiency and Conservation Authority Warm-up New Zealand: Heat Smart retrofit programme between July 2009 and June 2014.

Main outcome measure A difference-in-difference approach was used to compare the change in hospital admissions of the study population post-insulation with the change in hospital admissions of the control population that did not receive the intervention over the same two timeframes. Relative rate ratios were used to compare the two groups.

Results 234 873 hospital admissions occurred during the study period. Hospital admission rates after the intervention increased in the intervention and control groups for all population categories and conditions with the exception of acute hospital admissions among Pacific Peoples (rate ratio 0.94, 95% confidence interval 0.90 to 0.98), asthma (0.92, 0.86 to 0.99), cardiovascular disease (0.90, 0.88 to 0.93), and ischaemic heart disease for adults older than 65 years (0.79, 0.74 to 0.84). Post-intervention increases were, however, significantly lower (11%) in the intervention group compared with the control group (relative rate ratio 0.89, 95% confidence interval 0.88 to 0.90), representing 9.26 (95% confidence interval 9.05 to 9.47) fewer hospital admissions per 1000 in the intervention population. Effects were more pronounced for respiratory disease (0.85, 0.81 to 0.90), asthma in all age groups (0.80, 0.70 to 0.90), and ischaemic heart disease in those older than 65 years (0.75, 0.66 to 0.83).

Conclusion This study showed that a national home insulation intervention was associated with reduced hospital admissions, supporting previous research, which found an improvement in self-reported health.