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      Damp mouldy housing and early childhood hospital admissions for acute respiratory infection: a case control study

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          Abstract

          Introduction

          A gap exists in the literature regarding dose–response associations of objectively assessed housing quality measures, particularly dampness and mould, with hospitalisation for acute respiratory infection (ARI) among children.

          Methods

          A prospective, unmatched case–control study was conducted in two paediatric wards and five general practice clinics in Wellington, New Zealand, over winter/spring 2011–2013. Children aged <2 years who were hospitalised for ARI (cases), and either seen in general practice with ARI not requiring admission or for routine immunisation (controls) were included in the study. Objective housing quality was assessed by independent building assessors, with the assessors blinded to outcome status, using the Respiratory Hazard Index (RHI), a 13-item scale of household quality factors, including an 8-item damp–mould subscale. The main outcome was case–control status. Adjusted ORs (aORs) of the association of housing quality measures with case–control status were estimated, along with the population attributable risk of eliminating dampness–mould on hospitalisation for ARI among New Zealand children.

          Results

          188 cases and 454 controls were studied. Higher levels of RHI were associated with elevated odds of hospitalisation (OR 1.11/unit increase (95% CI 1.01 to 1.21)), which weakened after adjustment for season, housing tenure, socioeconomic status and crowding (aOR 1.04/unit increase (95% CI 0.94 to 1.15)). The damp–mould index had a significant, adjusted dose–response relationship with ARI admission (aOR 1.15/unit increase (95% CI 1.02 to 1.30)). By addressing these harmful housing exposures, the rate of admission for ARI would be reduced by 19% or 1700 fewer admissions annually.

          Conclusions

          A dose–response relationship exists between housing quality measures, particularly dampness–mould, and young children’s ARI hospitalisation rates. Initiatives to improve housing quality and to reduce dampness–mould would have a large impact on ARI hospitalisation.

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          Most cited references39

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          Meta-analyses of the associations of respiratory health effects with dampness and mold in homes.

          The Institute of Medicine (IOM) of the National Academy of Sciences recently completed a critical review of the scientific literature pertaining to the association of indoor dampness and mold contamination with adverse health effects. In this paper, we report the results of quantitative meta-analyses of the studies reviewed in the IOM report plus other related studies. We developed point estimates and confidence intervals (CIs) of odds ratios (ORs) that summarize the association of several respiratory and asthma-related health outcomes with the presence of dampness and mold in homes. The ORs and CIs from the original studies were transformed to the log scale and random effect models were applied to the log ORs and their variance. Models accounted for the correlation between multiple results within the studies analyzed. Central estimates of ORs for the health outcomes ranged from 1.34 to 1.75. CIs (95%) excluded unity in nine of 10 instances, and in most cases the lower bound of the CI exceeded 1.2. Based on the results of the meta-analyses, building dampness and mold are associated with approximately 30-50% increases in a variety of respiratory and asthma-related health outcomes. The results of these meta-analyses reinforce the IOM's recommendation that actions be taken to prevent and reduce building dampness problems, and also allow estimation of the magnitude of adverse public health impacts associated with failure to do so.
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            Effect of insulating existing houses on health inequality: cluster randomised study in the community.

            To determine whether insulating existing houses increases indoor temperatures and improves occupants' health and wellbeing. Community based, cluster, single blinded randomised study. Seven low income communities in New Zealand. 1350 households containing 4407 participants. Installation of a standard retrofit insulation package. Indoor temperature and relative humidity, energy consumption, self reported health, wheezing, days off school and work, visits to general practitioners, and admissions to hospital. Insulation was associated with a small increase in bedroom temperatures during the winter (0.5 degrees C) and decreased relative humidity (-2.3%), despite energy consumption in insulated houses being 81% of that in uninsulated houses. Bedroom temperatures were below 10 degrees C for 1.7 fewer hours each day in insulated homes than in uninsulated ones. These changes were associated with reduced odds in the insulated homes of fair or poor self rated health (adjusted odds ratio 0.50, 95% confidence interval 0.38 to 0.68), self reports of wheezing in the past three months (0.57, 0.47 to 0.70), self reports of children taking a day off school (0.49, 0.31 to 0.80), and self reports of adults taking a day off work (0.62, 0.46 to 0.83). Visits to general practitioners were less often reported by occupants of insulated homes (0.73, 0.62 to 0.87). Hospital admissions for respiratory conditions were also reduced (0.53, 0.22 to 1.29), but this reduction was not statistically significant (P=0.16). Insulating existing houses led to a significantly warmer, drier indoor environment and resulted in improved self rated health, self reported wheezing, days off school and work, and visits to general practitioners as well as a trend for fewer hospital admissions for respiratory conditions.
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              Health effects of passive smoking-10: Summary of effects of parental smoking on the respiratory health of children and implications for research.

              Two recent reviews have assessed the effect of parental smoking on respiratory disease in children. The results of the systematic quantitative review published as a series in Thorax are summarised and brought up to date by considering papers appearing on Embase or Medline up to June 1998. The findings are compared with those of the review published recently by the Californian Environmental Protection Agency (EPA). Areas requiring further research are identified. Overall there is a very consistent picture with odds ratios for respiratory illnesses and symptoms and middle ear disease of between 1.2 and 1.6 for either parent smoking, the odds usually being higher in pre-school than in school aged children. For sudden infant death syndrome the odds ratio for maternal smoking is about 2. Significant effects from paternal smoking suggest a role for postnatal exposure to environmental tobacco smoke. Recent publications do not lead us to alter the conclusions of our earlier reviews. While essentially narrative rather than systematic and quantitative, the findings of the Californian EPA review are broadly similar. In addition they have reviewed studies of the effects of environmental tobacco smoke on children with cystic fibrosis and conclude from the limited evidence that there is a strong case for a relationship between parental smoking and admissions to hospital. They also review data from adults of the effects of acute exposure to environmental tobacco smoke under laboratory conditions which suggest acute effects on spirometric parameters rather than on bronchial hyperresponsiveness. It seems likely that such effects are also present in children. Substantial benefits to children would arise if parents stopped smoking after birth, even if the mother smoked during pregnancy. Policies need to be developed which reduce smoking amongst parents and protect infants and young children from exposure to environmental tobacco smoke. The weight of evidence is such that new prevalence studies are no longer justified. What are needed are studies which allow comparison of the effects of critical periods of exposure to cigarette smoke, particularly in utero, early infancy, and later childhood. Where longitudinal studies are carried out they should be analysed to look at the way in which changes in exposure are related to changes in outcome. Better still would be studies demonstrating reversibility of adverse effects, especially in asthmatic subjects or children with cystic fibrosis.
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                Author and article information

                Contributors
                Role: Senior Research Fellow
                Journal
                Thorax
                Thorax
                thoraxjnl
                thorax
                Thorax
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                0040-6376
                1468-3296
                September 2019
                14 August 2019
                : 74
                : 9
                : 849-857
                Affiliations
                [1 ] departmentDepartment of Medicine , University of Otago Wellington , Wellington, New Zealand
                [2 ] departmentDepartment of Public Health , University of Otago Wellington , Wellington, New Zealand
                [3 ] departmentDepartment of Obstetrics and Gynaecology , University of Otago Wellington , Wellington, New Zealand
                [4 ] Tu Kotahi Māori Asthma Trust , Lower Hutt, New Zealand
                [5 ] departmentDepartment of Paediatrics , University of Otago Wellington , Wellington, New Zealand
                [6 ] departmentDepartment of Paediatrics , Capital and Coast District Health Board , Wellington, New Zealand
                [7 ] departmentDepartment of Paediatrics , Hutt Valley District Health Board , Lower Hutt, New Zealand
                Author notes
                [Correspondence to ] Dr Tristram Ingham, Department of Medicine, University of Otago Wellington, Wellington 6242, New Zealand; tristram.ingham@ 123456otago.ac.nz
                Author information
                http://orcid.org/0000-0001-7087-2531
                Article
                thoraxjnl-2018-212979
                10.1136/thoraxjnl-2018-212979
                6824607
                31413146
                216959b0-6fa6-44fc-be01-f530fa9d9572
                © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

                This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:  http://creativecommons.org/licenses/by-nc/4.0/.

                History
                : 27 January 2019
                : 17 June 2019
                : 24 June 2019
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100001505, Health Research Council of New Zealand;
                Award ID: 10-443
                Award ID: 11-370
                Categories
                Environmental Exposure
                1506
                2313
                Original article
                Custom metadata
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                Surgery
                acute respiratory infections,housing quality,dampness,mould,public health policy,child health
                Surgery
                acute respiratory infections, housing quality, dampness, mould, public health policy, child health

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