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Housing improvements for health and associated socio-economic outcomes

  1. Hilary Thomson1,*,
  2. Sian Thomas1,
  3. Eva Sellstrom2,
  4. Mark Petticrew3

Editorial Group: Cochrane Public Health Group

Published Online: 28 FEB 2013

Assessed as up-to-date: 13 AUG 2012

DOI: 10.1002/14651858.CD008657.pub2


How to Cite

Thomson H, Thomas S, Sellstrom E, Petticrew M. Housing improvements for health and associated socio-economic outcomes. Cochrane Database of Systematic Reviews 2013, Issue 2. Art. No.: CD008657. DOI: 10.1002/14651858.CD008657.pub2.

Author Information

  1. 1

    Medical Research Council, Social and Public Health Sciences Unit, Glasgow, UK

  2. 2

    Mid Sweden University, Department of Health Sciences, Östersund, Sweden

  3. 3

    London School of Hygiene and Tropical Medicine, Department of Social & Environmental Health Research, Faculty of Public Health & Policy, London, UK

*Hilary Thomson, Social and Public Health Sciences Unit, Medical Research Council, 4 Lilybank Gardens, Glasgow, G12 8RZ, UK. hilary@sphsu.mrc.ac.uk.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 28 FEB 2013

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Characteristics of included studies [ordered by study ID]
Allen 2005

MethodsUncontrolled before and after


ParticipantsResidents vulnerable to poor housing referred for health reasons to project (referral criteria- coronary heart disease, cerebro-vascular accident, peripheral vascular disease, type II diabetes with functional difficulties, chronic obstructive pulmonary disease, asthma children with complex and life limiting diseases). All income derived from welfare 46%, 83% of Pakistani origin.


InterventionsWarmth and energy efficiency improvements (after 1980)


OutcomesGHQ-12.


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)High riskUncontrolled before and after

Allocation concealment (selection bias)High riskUncontrolled before and after

Blinding of participants and personnel (performance bias)
Health
High riskNo control group

Blinding of outcome assessment (detection bias)
Health
High riskNo control group

Blinding of analystsHigh riskNo control group

Incomplete outcome data (attrition bias)
Health
Unclear riskReasons for missing data not reported

Selective reporting (reporting bias)Unclear riskNo protocol available

Baseline outcome characteristics similarHigh riskNo control group

Baseline characteristics similarHigh riskNo control group

ContaminationHigh riskNo control group

Baseline responseHigh riskSomewhat representative population and 50% baseline response

Implementation of interventionHigh riskIntervention varied considerably across sample

Allen 2005a

MethodsUncontrolled before and after


ParticipantsOwner occupiers (94%) with diagnosed serious heart condition. 60% <65 years, 80% lived in home >10 years, 62% Asian, 60% dependant on benefits


InterventionsWarmth and energy efficiency improvements (after 1980)


OutcomesSF-36 (PCS, MCS), Hospital Anxiety and Depression Scale (HADS).


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)High riskUncontrolled before and after

Allocation concealment (selection bias)High riskUncontrolled before and after

Blinding of participants and personnel (performance bias)
Health
High riskNo control group

Blinding of outcome assessment (detection bias)
Health
High riskNo control group

Blinding of analystsHigh riskNo control group

Incomplete outcome data (attrition bias)
Health
Unclear riskInsufficient data reported to permit judgement

Selective reporting (reporting bias)Unclear riskNo protocol available

Baseline outcome characteristics similarHigh riskNo control group

Baseline characteristics similarHigh riskNo control group

ContaminationHigh riskNo control group

Baseline responseUnclear riskRepresentative population but baseline response unclear

Implementation of interventionHigh riskIntervention varied considerably across sample

Ambrose 2000

MethodsUncontrolled before and after


ParticipantsSocial housing tenants. High levels of socio-economic deprivation ( in receipt of income support 65.4%; unemployed 9.2%). Bangladeshi 69.2%, White 18.7%


InterventionsRehousing or retrofitting with or without neighbourhood renewal (after 1995)


OutcomesIllness episodes, symptoms: cough/cold, asthmatic/bronchial, stress/depression, dietary/digestive, aches/pains. Health service use (primary care, hospital admission), medication. Employment.


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)High riskUncontrolled before and after

Allocation concealment (selection bias)High riskUncontrolled before and after

Blinding of participants and personnel (performance bias)
Health
High riskNo control group

Blinding of outcome assessment (detection bias)
Health
High riskNo control group

Blinding of analystsHigh riskNo control group

Incomplete outcome data (attrition bias)
Health
Unclear riskReasons for missing data unclear

Selective reporting (reporting bias)Unclear riskNo protocol available

Baseline outcome characteristics similarHigh riskNo control group

Baseline characteristics similarHigh riskNo control group

ContaminationHigh riskNo control group

Baseline responseLow riskRepresentative population and 89% baseline response

Implementation of interventionHigh riskIntervention varied considerably across sample

Aziz 1990

MethodsCross-sectional controlled before and after


ParticipantsChildren living in agricultural villages in rural Bangladesh. Household data: % Illiterate adults male/female 49/78, 77% Muslim


InterventionsProvision of basic housing needs/developing country intervention


OutcomesParent reported or clinic reported child episodes of diarrhoea.


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)High riskCross-sectional controlled before and after

Allocation concealment (selection bias)High riskCross-sectional controlled before and after

Blinding of participants and personnel (performance bias)
Health
Unclear riskNo report of blinding of study participants or personnel

Blinding of outcome assessment (detection bias)
Health
Unclear riskNo report of blinding of outcome assessors

Blinding of analystsUnclear riskNo report of blinding of data analysts

Incomplete outcome data (attrition bias)
Health
Unclear riskAnalysis at village level - no indication of missing individual level data

Selective reporting (reporting bias)Unclear riskNo protocol available

Baseline outcome characteristics similarLow riskBaseline health status similar

Baseline characteristics similarLow riskBaseline socio-demographics and living conditions similar

ContaminationUnclear riskCannot tell

Baseline responseUnclear riskRepresentative population and baseline response not reported

Implementation of interventionUnclear riskSome variation in intervention across sample

Barnes 2003

MethodsControlled before and after


ParticipantsSocial housing tenants. Mixed age groups, 32% have some form of disability. Ethnicity: 65% White; 23% Black/Asian


InterventionsRehousing or retrofitting with or without neighbourhood renewal (after 1995)


OutcomesSelf-reported health, health problems/emotional problems interfering with daily activities, self-reported pain, discomfort, anxiety, depression. Health service use (primary care).


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)High riskControlled before and after

Allocation concealment (selection bias)High riskControlled before and after

Blinding of participants and personnel (performance bias)
Health
Unclear riskNo report of blinding of study participants or personnel

Blinding of outcome assessment (detection bias)
Health
Unclear riskNo report of blinding of outcome assessors

Blinding of analystsUnclear riskNo report of blinding of data analysts

Incomplete outcome data (attrition bias)
Health
Unclear riskNo indication of missing data for individual outcomes

Selective reporting (reporting bias)Unclear riskNo protocol available

Baseline outcome characteristics similarHigh riskControl group had poorer health, not controlled for in analysis

Baseline characteristics similarHigh riskControl group older and not eligible for housing improvement

ContaminationUnclear riskCannot tell

Baseline responseLow riskSomewhat representative population and 95% baseline response

Implementation of interventionHigh riskIntervention varied considerably across sample

Barton 2007

MethodsRandomised controlled (stepped wedge) design


ParticipantsSocial housing tenants in deprived area (Jarman index of socio-economic deprivation 22.7, regional level of 12.8 (Devon)). 58% <20 years, 10% <50 years


InterventionsWarmth and energy efficiency improvements (after 1980)


OutcomesChild and adult reported asthma symptoms (summed), itchy eyes, water eyes, runny nose, blocked nose, rheumatism, arthritis.


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Low riskOut of a bucket by councillor at public meeting

Allocation concealment (selection bias)Low riskOut of a bucket by councillor at public meeting

Blinding of participants and personnel (performance bias)
Health
Unclear riskNo report of blinding of study participants or personnel

Blinding of outcome assessment (detection bias)
Health
Unclear riskNo report of blinding of outcome assessors

Blinding of analystsUnclear riskNo report of blinding of data analysts

Incomplete outcome data (attrition bias)
Health
Unclear riskNo indication of missing data for individual outcomes

Selective reporting (reporting bias)High riskLung function data reported in trial register to be collected but not reported. No protocol available

Baseline outcome characteristics similarLow riskBaseline reported asthma similar

Baseline characteristics similarLow riskBaseline socio-demographic data and housing quality similar

ContaminationUnclear riskCannot tell

Baseline responseLow riskRepresentative population and 94% baseline response

Implementation of interventionHigh riskIntervention varied considerably across sample

Blackman 2001

MethodsUncontrolled before and after


ParticipantsResidents of neighbourhood renewal area, mixed tenure (56.1% owner occupier; 29.6% social rented), 41.8% in receipt of housing benefit/household with no wage earner; 73.5% 5 years or more lived at this address. 96.4% White; Male/Female 32%/68%; age 0-15 yrs 20.6%; age 16 to 64 yrs 67.5%; age 65+ yrs 12%; Household type (%) n=98 households; Adults plus children 36.1%; non-pensioner adult(s) only 35.1%; 1+ pensioner household 28.9%


InterventionsRehousing or retrofitting with or without neighbourhood renewal (after 1995)


OutcomesSelf-reported health, self-reported acute respiratory health, (children and adults). Self-reported mental health problem (adults/children). Self-reported health service use, prescribed medication.


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)High riskUncontrolled before and after

Allocation concealment (selection bias)High riskUncontrolled before and after

Blinding of participants and personnel (performance bias)
Health
High riskNo control group

Blinding of outcome assessment (detection bias)
Health
High riskNo control group

Blinding of analystsHigh riskNo control group

Incomplete outcome data (attrition bias)
Health
Unclear riskReasons for missing data not reported

Selective reporting (reporting bias)Unclear riskNo protocol available

Baseline outcome characteristics similarHigh riskNo control group

Baseline characteristics similarHigh riskNo control group

ContaminationHigh riskNo control group

Baseline responseLow riskRepresentative population and 70% baseline response

Implementation of interventionUnclear riskIntervention varied across sample but unclear to what extent

Braubach 2008

MethodsControlled before and after


ParticipantsResidents of social housing in three neighbourhoods of Frankfurt. Mean age 46 years (range 1-97; 1-17 years 13%, 18-64 years 60%, >64 years 27%); Male/Female 42%/58%. Mix of low and middle income households


InterventionsWarmth and energy efficiency improvements (after 1980)


OutcomesAsthma attacks, sick days, common cold, acute bronchitis/emphysema, depression, self-reported health.


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)High riskControlled before and after

Allocation concealment (selection bias)High riskControlled before and after

Blinding of participants and personnel (performance bias)
Health
Unclear riskNo report of blinding of study participants or personnel

Blinding of outcome assessment (detection bias)
Health
Unclear riskNo report of blinding of outcome assessors

Blinding of analystsUnclear riskNo report of blinding of data analysts

Incomplete outcome data (attrition bias)
Health
Unclear riskInsufficient data reported to permit judgement

Selective reporting (reporting bias)Unclear riskNo protocol available

Baseline outcome characteristics similarLow riskHealth outcomes similar

Baseline characteristics similarUnclear riskInsufficient data to permit judgement

ContaminationUnclear risk4% control group received intervention

Baseline responseHigh riskRepresentative population and 42% baseline response

Implementation of interventionUnclear riskSome variation of intervention across sample

Breysse 2011

MethodsRetrospective uncontrolled


ParticipantsLow income (annual household income $28,000), minority ethnic groups (Adults: White-Hispanic 9%; White-nonHispanic 36%; African 32%, African-American 9%), 67% Female. 57% adults born outside USA


InterventionsRehousing or retrofitting with or without neighbourhood renewal (after 1995)


OutcomesSelf-reported change in: general health, respiratory health, and injuries (adults and children).


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)High riskRetrospective uncontrolled

Allocation concealment (selection bias)High riskRetrospective uncontrolled

Blinding of participants and personnel (performance bias)
Health
High riskNo control group

Blinding of outcome assessment (detection bias)
Health
High riskNo control group

Blinding of analystsHigh riskNo control group

Incomplete outcome data (attrition bias)
Health
Unclear riskReasons for missing data not reported

Selective reporting (reporting bias)Unclear riskNo protocol available

Baseline outcome characteristics similarHigh riskNo control group

Baseline characteristics similarHigh riskNo control group

ContaminationHigh riskNo control group

Baseline responseUnclear riskVery representative and 57% baseline response

Implementation of interventionUnclear riskIntervention delivered to meet pre-specified standard and intervention varied to some extent as baseline conditions were not identical

Chapin 1938

MethodsUncontrolled before and after


ParticipantsResidents of housing with inadequate facilities in neighbourhood with high crime rate. Many households foreign born with large families. Ethnicity: Black 62%, Jewish 23%, White 15%


InterventionsRehousing from slums (before 1970)


OutcomesMorale ('scale to measure degree to which the individual feels competent to cope with the future and achieve his desired goals'), adjustment - 'measure of generalised adjustment'.


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)High riskUncontrolled before and after

Allocation concealment (selection bias)High riskUncontrolled before and after

Blinding of participants and personnel (performance bias)
Health
High riskNo control group

Blinding of outcome assessment (detection bias)
Health
High riskNo control group

Blinding of analystsHigh riskNo control group

Incomplete outcome data (attrition bias)
Health
Unclear riskInsufficient data reported to permit judgement

Selective reporting (reporting bias)Unclear riskNo protocol available

Baseline outcome characteristics similarHigh riskNo control group

Baseline characteristics similarHigh riskNo control group

ContaminationHigh riskNo control group

Baseline responseHigh riskSomewhat representative population and 50% baseline response

Implementation of interventionLow riskMinimal variation in intervention across sample

CHARISMA 2011

MethodsRandomised controlled trial


ParticipantsChildren aged 5-14 years prescribed >2 steroid inhalers in past year


InterventionsWarmth and energy efficiency improvements (after 1980)


OutcomesPedsQL. Parent completed asthma specific and general quality of life measure. Days off school.


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Low riskContemporaneous dynamic randomisation

Allocation concealment (selection bias)Low riskRandomisation performed centrally

Blinding of participants and personnel (performance bias)
Health
Unclear riskNo report of blinding of study participants or personnel

Blinding of outcome assessment (detection bias)
Health
Unclear riskNo report of blinding of outcome assessors

Blinding of analystsLow riskAnalyst blinded to allocation

Incomplete outcome data (attrition bias)
Health
Unclear riskNo indication of missing data for individual outcomes

Selective reporting (reporting bias)Low riskProtocol (provided by authors) states primary outcome as reported

Baseline outcome characteristics similarLow riskBaseline asthma measures similar

Baseline characteristics similarUnclear riskData on baseline characteristics reported for age eligibility but not socio-economic status

ContaminationUnclear riskCannot tell

Baseline responseHigh riskVery representative of population but only 43.8% baseline response

Implementation of interventionHigh riskIntervention varied considerably across sample

Critchley 2004

MethodsControlled before and after


ParticipantsSocial housing tenants. Predominantly retired and dependent on welfare: 66% > 60 years


InterventionsRehousing or retrofitting with or without neighbourhood renewal (after 1995)


OutcomesSF-36 (8 domains presented but not analysed by 2 main SF-36 components), self-reported health service use (primary care), affordability.


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)High riskControlled before and after

Allocation concealment (selection bias)High riskControlled before and after

Blinding of participants and personnel (performance bias)
Health
Unclear riskNo report of blinding of study participants or personnel

Blinding of outcome assessment (detection bias)
Health
Unclear riskNo report of blinding of outcome assessors

Blinding of analystsUnclear riskNo report of blinding of data analysts

Incomplete outcome data (attrition bias)
Health
Unclear riskReasons for missing data not reported by intervention/control

Selective reporting (reporting bias)Unclear riskNo protocol available

Baseline outcome characteristics similarUnclear riskInsufficient data to permit judgement

Baseline characteristics similarUnclear riskSimilar eligibility for housing improvement but socio-demographic differences and unclear if this controlled for in analysis

ContaminationUnclear riskCannot tell

Baseline responseHigh riskSomewhat representative population and 55% baseline response

Implementation of interventionLow riskMinimal variation in intervention across sample

Evans 2000

MethodsControlled before and after


ParticipantsPrivate householders in socio-economically deprived urban area


InterventionsRehousing or retrofitting with or without neighbourhood renewal (after 1995)


OutcomesSF-36 (selected questions).


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)High riskControlled before and after

Allocation concealment (selection bias)High riskControlled before and after

Blinding of participants and personnel (performance bias)
Health
Unclear riskNo report of blinding of study participants or personnel

Blinding of outcome assessment (detection bias)
Health
Unclear riskNo report of blinding of outcome assessors

Blinding of analystsUnclear riskNo report of blinding of data analysts

Incomplete outcome data (attrition bias)
Health
Unclear riskReasons for missing data not reported

Selective reporting (reporting bias)Unclear riskNo protocol available

Baseline outcome characteristics similarUnclear riskSmall differences but unclear if statistically significant, not controlled for in analysis

Baseline characteristics similarUnclear riskInsufficient data to permit judgement, differences not controlled for in analysis

ContaminationUnclear riskCannot tell

Baseline responseUnclear riskSelection process unclear, baseline response not reported

Implementation of interventionHigh riskIntervention varied considerably across sample

Halpern 1995

MethodsCross-sectional uncontrolled before and after (some control group data)


ParticipantsSocial housing tenants. High number female single parent families; Mean age females interviewed at stage 1, 2 ,3 = 42.4, 39.8, 40.2 years respectively. Mean years at present house 8.2; mean number of children <14 years 1.4; 37% employed; mean reported household income £97-134/wk


InterventionsRehousing or retrofitting with or without neighbourhood renewal (after 1995)


OutcomesHospital Anxiety and Depression Scale (HADS), self esteem.


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)High riskCross-sectional uncontrolled before and after

Allocation concealment (selection bias)High riskUncontrolled before and after

Blinding of participants and personnel (performance bias)
Health
High riskNo control group data

Blinding of outcome assessment (detection bias)
Health
High riskNo control group data

Blinding of analystsHigh riskNo control group data

Incomplete outcome data (attrition bias)
Health
Unclear riskInsufficient data reported to permit judgement

Selective reporting (reporting bias)Unclear riskNo protocol available

Baseline outcome characteristics similarHigh riskNo control group data

Baseline characteristics similarHigh riskSimilar socio-demographics, differences in eligibility for improvement and housing quality unclear, final follow-up control group data not reported

ContaminationHigh riskCannot tell and limited control group data

Baseline responseUnclear riskSomewhat representative population and 60-70% baseline response

Implementation of interventionHigh riskIntervention varied considerably across sample

Health Action Kirklees

MethodsRetrospective uncontrolled


ParticipantsPrivate householders, under 60 years/with young children/not in receipt of welfare, who suffer from or are at risk from cold related illness (confirmed by health professional)


InterventionsWarmth and energy efficiency improvements (after 1980)


OutcomesSelf-reported health, health service use, medication use.


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)High riskRetrospective uncontrolled study

Allocation concealment (selection bias)High riskRetrospective uncontrolled study

Blinding of participants and personnel (performance bias)
Health
High riskNo control group

Blinding of outcome assessment (detection bias)
Health
High riskNo control group

Blinding of analystsHigh riskNo control group

Incomplete outcome data (attrition bias)
Health
High riskRetrospective study

Selective reporting (reporting bias)Unclear riskNo protocol available

Baseline outcome characteristics similarHigh riskNo control group

Baseline characteristics similarHigh riskNo control group

ContaminationHigh riskNo control group

Baseline responseLow riskRepresentative population and 73% baseline response

Implementation of interventionUnclear riskIntervention varied across sample but unclear to what extent

Hopton 1996

MethodsControlled before and after


ParticipantsSocial housing tenants in isolated deprived neighbourhood: 42% household with someone unemployed


InterventionsWarmth and energy efficiency improvements (after 1980)


OutcomesParent reported children's symptoms (list of 16).


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)High riskControlled before and after

Allocation concealment (selection bias)High riskControlled before and after

Blinding of participants and personnel (performance bias)
Health
Unclear riskNo report of blinding of study participants or personnel

Blinding of outcome assessment (detection bias)
Health
Unclear riskNo report of blinding of outcome assessors

Blinding of analystsUnclear riskNo report of blinding of data analysts

Incomplete outcome data (attrition bias)
Health
Unclear riskReasons for missing data not reported by intervention/control, and numbers not reported by outcome

Selective reporting (reporting bias)Unclear riskNo protocol available

Baseline outcome characteristics similarUnclear riskInsufficient data to permit judgement

Baseline characteristics similarUnclear riskBoth groups from same housing area but other similarities unclear

ContaminationUnclear riskCannot tell

Baseline responseLow riskRepresentative population and 83% baseline response

Implementation of interventionUnclear riskIntervention varied across sample but unclear to what extent

Howden-Chapman 2007

MethodsRandomised controlled trial


ParticipantsVarious tenures (24% rented, 76% owner occupier - nationally 32%/68%). At least one person in household suffered from respiratory disease, lived in uninsulated house. 66% in bottom 3 deciles of deprived areas. Ethnicity: 49% Maori migrant pacific. 66% in bottom 3 deciles of deprived areas


InterventionsWarmth and energy efficiency improvements (after 1980)


OutcomesSelf-reported health, self-reported wheezing, morning phlegm, sleep disturbed by wheezing, speech disturbed by wheezing, SF-36 (selected questions reported). Health service use (primary care and hospital admission for respiratory condition). Attendance at or days off school or work.


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Unclear riskRandomisation sequence generated by independent researcher

Allocation concealment (selection bias)Low riskRandomisation sequence generated by independent researcher

Blinding of participants and personnel (performance bias)
Health
Unclear riskNo report of blinding of participants or personnel

Blinding of outcome assessment (detection bias)
Health
Unclear riskNo report of blinding of outcome assessors

Blinding of analystsUnclear riskNo report of blinding of data analysts

Incomplete outcome data (attrition bias)
Health
Low riskSimilar numbers and reasons for missing data across groups

Selective reporting (reporting bias)Unclear riskIncomplete SF-36 data reported, no protocol available.

Baseline outcome characteristics similarLow riskBaseline health outcomes similar

Baseline characteristics similarLow riskBaseline socio-demographics and housing quality similar

ContaminationUnclear riskCannot tell

Baseline responseUnclear riskSomewhat representative of population but baseline response not reported

Implementation of interventionHigh riskIntervention varied considerably across sample

Howden-Chapman 2008

MethodsRandomised controlled trial


ParticipantsFour New Zealand cities. Households with child (6-12 years) with doctor diagnosed asthma in house with main form of heating plug in heater or unflued LPG heater. Mean age 9.6 years, ˜58.5% male, ˜36.5% Maori (compared to 15% general population), 47% NZ European Int/Cont


InterventionsWarmth and energy efficiency improvements (after 1980)


OutcomesPeak flow, FEV, LRS, URS, cough (various measures), use of inhalers, wheeze, diarrhoea, vomiting, infections, twisted ankle, health service use related to asthma, days of school.


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Unclear riskRandomisation sequence generated by independent researcher

Allocation concealment (selection bias)Low riskRandomisation sequence generated by independent researcher

Blinding of participants and personnel (performance bias)
Health
Unclear riskNo report of blinding of study participants or study personnel

Blinding of outcome assessment (detection bias)
Health
Unclear riskNo report of blinding of outcome assessors

Blinding of analystsUnclear riskNo report of blinding of data analysts

Incomplete outcome data (attrition bias)
Health
Low riskSimilar numbers and reasons for missing data across groups

Selective reporting (reporting bias)Unclear riskNo protocol available

Baseline outcome characteristics similarLow riskBaseline health outcomes similar

Baseline characteristics similarLow riskBaseline socio-demographics & housing quality similar

ContaminationUnclear riskCannot tell

Baseline responseUnclear riskSomewhat representative of population but baseline response not reported

Implementation of interventionUnclear riskSome variation in intervention across sample

Iversen 1986

MethodsControlled before and after


ParticipantsPrivate low-rise flatted housing in middle income area


InterventionsWarmth and energy efficiency improvements (after 1980)


OutcomesSymptoms: eye irritation, joint pains, dry throat.


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)High riskControlled before and after

Allocation concealment (selection bias)High riskControlled before and after

Blinding of participants and personnel (performance bias)
Health
Unclear riskNo report of blinding of study participants or personnel

Blinding of outcome assessment (detection bias)
Health
Unclear riskNo report of blinding of outcome assessors

Blinding of analystsUnclear riskNo report of blinding of data analysts

Incomplete outcome data (attrition bias)
Health
Unclear riskReasons for missing data not reported

Selective reporting (reporting bias)Unclear riskNo protocol available

Baseline outcome characteristics similarLow riskBaseline outcome value controlled for in analysis

Baseline characteristics similarLow riskAnalysis controlled for differences in area, age, sex and smoking

ContaminationUnclear riskCannot tell

Baseline responseUnclear riskRepresentativeness and selection unclear, 54% baseline response

Implementation of interventionLow riskMinimal variation in intervention across sample

Kearns 2008

MethodsControlled before and after


ParticipantsSocial housing tenants. Age <30 yrs 15.8%; >60 yrs 14.4%; 77.9% urban resident, 21.4% rural resident


InterventionsRehousing or retrofitting with or without neighbourhood renewal (after 1995)


OutcomesSF-36, common symptoms, psycho-social benefits plus qualitative data. Income and affordability.


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)High riskControlled before and after

Allocation concealment (selection bias)High riskControlled before and after

Blinding of participants and personnel (performance bias)
Health
Unclear riskNo report of blinding of study participants or personnel

Blinding of outcome assessment (detection bias)
Health
Unclear riskNo report of blinding of outcome assessors

Blinding of analystsUnclear riskNo report of blinding of data analysts

Incomplete outcome data (attrition bias)
Health
Unclear riskReasons for missing data not reported

Selective reporting (reporting bias)Unclear riskNo protocol available

Baseline outcome characteristics similarLow riskBaseline health differences controlled for in analysis

Baseline characteristics similarHigh riskControl group lived in better quality housing and older than intervention group

ContaminationUnclear riskCannot tell

Baseline responseUnclear riskBaseline response not reported

Implementation of interventionUnclear riskIntervention varied across sample but unclear to what extent

Lloyd 2008

MethodsControlled before and after


ParticipantsSocial housing tenants in deprived neighbourhood


InterventionsWarmth and energy efficiency improvements (after 1980)


OutcomesBlood pressure.


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)High riskControlled before and after

Allocation concealment (selection bias)High riskControlled before and after

Blinding of participants and personnel (performance bias)
Health
Unclear riskNo report of blinding of study participants or personnel

Blinding of outcome assessment (detection bias)
Health
Unclear riskNo report of blinding of outcome assessors

Blinding of analystsUnclear riskNo report of blinding of data analysts

Incomplete outcome data (attrition bias)
Health
Unclear riskReasons for missing data not reported by intervention/control

Selective reporting (reporting bias)Unclear riskNo protocol available

Baseline outcome characteristics similarLow riskBlood pressure at baseline similar

Baseline characteristics similarUnclear riskHousing type similar but insufficient socio-demographic data to permit judgement

ContaminationUnclear riskCannot tell

Baseline responseLow riskRepresentative population and 72% baseline response

Implementation of interventionUnclear riskIntervention varied across sample but unclear to what extent

McGonigle 1936

MethodsCross-sectional controlled before and after


ParticipantsResidents of slum areas with higher mortality rates than rest of England and local borough; 18.75 and 22.15 deaths per 1000 compared with 12.00 and 13.96


InterventionsRehousing from slums (before 1970)


OutcomesStandardized death rates (adult and infant); adequacy of diet, income and affordability, employment.


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)High riskCross-sectional controlled before and after

Allocation concealment (selection bias)High riskCross-sectional controlled before and after

Blinding of participants and personnel (performance bias)
Health
Unclear riskNo report of blinding of study participants or personnel

Blinding of outcome assessment (detection bias)
Health
Unclear riskNo report of blinding of outcome assessors

Blinding of analystsUnclear riskNo report of blinding of data analysts

Incomplete outcome data (attrition bias)
Health
Unclear riskReasons for missing data not reported

Selective reporting (reporting bias)Unclear riskNo protocol available

Baseline outcome characteristics similarUnclear riskBoth areas had similar outcomes but insufficient data to permit judgement

Baseline characteristics similarUnclear riskBoth groups from similar areas but insufficient data to permit judgement

ContaminationUnclear riskCannot tell

Baseline responseUnclear riskSomewhat representative population and area level data used

Implementation of interventionUnclear riskIntervention varied across sample but unclear to what extent

Molnar 2010

MethodsUncontrolled before and after


ParticipantsRoma adults living in disadvantaged rural village. Previously living in life-threatening conditions


InterventionsRehousing or retrofitting with or without neighbourhood renewal (after 1995)


OutcomesFunctional limitations, chronic disease, infections, injuries.


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)High riskUncontrolled before and after

Allocation concealment (selection bias)High riskUncontrolled before and after

Blinding of participants and personnel (performance bias)
Health
High riskNo control group

Blinding of outcome assessment (detection bias)
Health
High riskNo control group

Blinding of analystsHigh riskNo control group

Incomplete outcome data (attrition bias)
Health
Unclear riskNo indication of missing data for individual outcomes

Selective reporting (reporting bias)Unclear riskNo protocol available

Baseline outcome characteristics similarHigh riskNo control group

Baseline characteristics similarHigh riskNo control group

ContaminationHigh riskNo control group

Baseline responseUnclear riskRepresentativeness and baseline response unclear

Implementation of interventionHigh riskMix of refurbishment and rehousing

Osman 2010

MethodsRandomised controlled trial


ParticipantsElderly people with recent hospital admission for COPD living in own homes (47% social housing)


InterventionsWarmth and energy efficiency improvements (after 1980)


OutcomesSt Georges Respiratory Questionnaire, Euroqol Visual Analogue Scale, fuel costs.


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Unclear riskMethod of sequence generation not reported

Allocation concealment (selection bias)Unclear riskMethod of allocation concealment not described

Blinding of participants and personnel (performance bias)
Health
Unclear riskNo report of blinding of study participants or personnel

Blinding of outcome assessment (detection bias)
Health
Unclear riskNo report of blinding of outcome assessors

Blinding of analystsUnclear riskNo report of blinding of data analysts

Incomplete outcome data (attrition bias)
Health
Unclear riskUnclear reasons for withdrawals reported, ITT analysis, but no indication of missing data

Selective reporting (reporting bias)Low riskProject summary and protocol available and all stated outcomes reported

Baseline outcome characteristics similarLow riskBaseline health status similar

Baseline characteristics similarLow riskBaseline socio-demographic data, eligibility for improvement and housing quality similar

ContaminationHigh risk18% control group received intervention

Baseline responseUnclear riskSomewhat representative and baseline response not reported

Implementation of interventionUnclear riskIntervention varied across sample but unclear to what extent

Platt 2007

MethodsControlled before and after


ParticipantsSocial housing tenants (53.5%) and owner-occupiers (41.5%). Mean age 62 years, Male/Female 36%/64%, socio-economically deprived 61%, predominantly pensioners with no children in house


InterventionsWarmth and energy efficiency improvements (after 1980)


OutcomesSF-36 (2 domains presented), self-reported symptoms (17, includes first diagnosis of: heart disease, nasal allergy, hypertension, smoking). 4 self-report health service use, 2 self-reported medication use. Income and affordability, social contact and relationships within the household and beyond.


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)High riskControlled before and after

Allocation concealment (selection bias)High riskControlled before and after

Blinding of participants and personnel (performance bias)
Health
Unclear riskNo report of blinding of study participants or personnel

Blinding of outcome assessment (detection bias)
Health
Unclear riskNo report of blinding of outcome assessors

Blinding of analystsUnclear riskNo report of blinding of data analysts

Incomplete outcome data (attrition bias)
Health
Unclear riskSome differences between intervention/control group but insufficient data to judge

Selective reporting (reporting bias)Unclear riskNo protocol available

Baseline outcome characteristics similarLow riskAnalysis controlled for baseline outcome value

Baseline characteristics similarUnclear riskSimilar socio-demographic data and house type. Control group not eligible for housing improvement and some already had intervention

ContaminationHigh risk13% control group had intervention at baseline

Baseline responseUnclear riskBaseline response not reported

Implementation of interventionLow riskMinimal variation in intervention across sample

Rojas de Arias 1999

MethodsControlled before and after (three intervention groups)


ParticipantsRural households 50-100km from capital of Paraguay. Housing mainly made of mud walls and thatched rooves


InterventionsProvision of basic housing needs/developing country intervention


OutcomesSero-positivity of Triatomine cruzi (ELISA and IIF).


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)High riskControlled before and after

Allocation concealment (selection bias)High riskControlled before and after

Blinding of participants and personnel (performance bias)
Health
Unclear riskNo report of blinding of study participants or personnel

Blinding of outcome assessment (detection bias)
Health
Unclear riskNo report of blinding of outcome assessors

Blinding of analystsUnclear riskNo report of blinding of data analysts

Incomplete outcome data (attrition bias)
Health
Unclear riskReasons for missing data not reported

Selective reporting (reporting bias)Unclear riskNo protocol available

Baseline outcome characteristics similarHigh riskNo data provided

Baseline characteristics similarHigh riskNo data provided

ContaminationUnclear riskCannot tell

Baseline responseUnclear riskBaseline response not reported

Implementation of interventionUnclear riskAnalysis of 3 groups by intervention received but intervention delivered to 67-90% sample

Shortt 2007

MethodsControlled before and after


ParticipantsHigh percentage >60 years and <5 years. High proportion owner occupiers/private rented housing in rural areas, in receipt of welfare benefits. 78% Int group houses built pre-1950. Low uptake of domestic energy efficiency improvements; Areas in middle range of deprivation index.


InterventionsWarmth and energy efficiency improvements (after 1980)


OutcomesSelf-reported health, GP data on small number, self-reported respiratory conditions, angina and mental/stress conditions. Income and affordability.


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)High riskControlled before and after

Allocation concealment (selection bias)High riskControlled before and after

Blinding of participants and personnel (performance bias)
Health
Unclear riskNo report of blinding of study participants or personnel

Blinding of outcome assessment (detection bias)
Health
Unclear riskNo report of blinding of outcome assessors

Blinding of analystsUnclear riskNo report of blinding of data analysts

Incomplete outcome data (attrition bias)
Health
Unclear riskNo indication of missing data for individual outcomes

Selective reporting (reporting bias)Unclear riskNo protocol available

Baseline outcome characteristics similarHigh riskControl group health outcomes better

Baseline characteristics similarHigh riskControl group not eligible for improvement, lived in newer houses and were younger, differences not controlled for in analysis

ContaminationUnclear riskCannot tell

Baseline responseUnclear riskSomewhat representative population, baseline response not reported

Implementation of interventionHigh riskIntervention varied considerably across sample

Somerville 2000

MethodsUncontrolled before and after


ParticipantsAsthmatic children under 16 years living in social housing reported to have damp


InterventionsWarmth and energy efficiency improvements (after 1980)


OutcomesSelf-rated asthma symptoms (summed score of cough by day/night, wheeze by day/night, breathless with exercise, breathless), hay fever, diarrhoea. Attendance at or days off school or work.


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)High riskUncontrolled before and after

Allocation concealment (selection bias)High riskUncontrolled before and after

Blinding of participants and personnel (performance bias)
Health
High riskNo control group

Blinding of outcome assessment (detection bias)
Health
High riskNo control group

Blinding of analystsHigh riskNo control group

Incomplete outcome data (attrition bias)
Health
Unclear riskInsufficient data reported to permit judgement

Selective reporting (reporting bias)Unclear riskNo protocol available

Baseline outcome characteristics similarHigh riskNo control group

Baseline characteristics similarHigh riskNo control group

ContaminationHigh riskNo control group

Baseline responseLow riskSomewhat representative population and 75% baseline response, selection unclear

Implementation of interventionUnclear riskSome variation in intervention across sample

Spiegel 2003

MethodsCross-sectional controlled before and after


ParticipantsUrban neighbourhood with predominantly dilapidated buildings and inadequate basic amenities such as potable water. Male/Female 41%/59%, mean age 45.1 years, education 11.2 years (mean), Ethnicity: White 58%, Mulatto/Black 36%


InterventionsProvision of basic housing needs/developing country intervention


OutcomesSelf-reported health, smoking, respiratory illness, suicide attempts.


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)High riskCross-sectional controlled before and after

Allocation concealment (selection bias)High riskCross-sectional controlled before and after

Blinding of participants and personnel (performance bias)
Health
Unclear riskNo report of blinding of study participants or personnel

Blinding of outcome assessment (detection bias)
Health
Unclear riskNo report of blinding of outcome assessors

Blinding of analystsUnclear riskNo report of blinding of data analysts

Incomplete outcome data (attrition bias)
Health
High riskRetrospective design

Selective reporting (reporting bias)Unclear riskNo protocol available

Baseline outcome characteristics similarUnclear riskSome differences in suicide and respiratory outcomes

Baseline characteristics similarUnclear riskArea location and type similar

ContaminationUnclear riskCannot tell

Baseline responseUnclear riskSomewhat representative population but baseline response not reported

Implementation of interventionHigh riskIntervention varied considerably across sample

Thomas 2005

MethodsControlled before and after


ParticipantsSocial housing tenants in deprived area. Mean age Int/Cont 51/53, Male/Female 52%/48%


InterventionsRehousing or retrofitting with or without neighbourhood renewal (after 1995)


OutcomesGHQ-12.


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)High riskControlled before and after

Allocation concealment (selection bias)High riskControlled before and after

Blinding of participants and personnel (performance bias)
Health
Unclear riskNo report of blinding of study participants or personnel

Blinding of outcome assessment (detection bias)
Health
Unclear riskNo report of blinding of outcome assessors

Blinding of analystsUnclear riskNo report of blinding of data analysts

Incomplete outcome data (attrition bias)
Health
Unclear riskInsufficient data reported to permit judgement

Selective reporting (reporting bias)Unclear riskNo protocol available

Baseline outcome characteristics similarLow riskGHQ score similar at baseline

Baseline characteristics similarUnclear riskSocio-demographics similar, but unclear if housing quality, type & eligibility for improvement similar. Analysis controlled for differences in area and age

ContaminationHigh risk55% control area and 65% intervention area received housing improvement

Baseline responseHigh riskSomewhat representative population and 17% baseline response

Implementation of interventionHigh riskIntervention varied considerably across sample

Thomson 2007

MethodsControlled before and after


ParticipantsSocial housing tenants. More than half of participants were dependent on housing benefit


InterventionsRehousing or retrofitting with or without neighbourhood renewal (after 1995)


OutcomesSelf-reported health, SF-36 (PCS & MCS).


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)High riskControlled before and after

Allocation concealment (selection bias)High riskControlled before and after

Blinding of participants and personnel (performance bias)
Health
Unclear riskNo report of blinding of study participants or personnel

Blinding of outcome assessment (detection bias)
Health
Unclear riskNo report of blinding of outcome assessors

Blinding of analystsUnclear riskNo report of blinding of data analysts

Incomplete outcome data (attrition bias)
Health
Unclear riskReasons for missing data not reported

Selective reporting (reporting bias)Unclear riskNo protocol available

Baseline outcome characteristics similarLow riskHealth outcomes similar at baseline

Baseline characteristics similarLow riskBoth groups similar socio-demographics and housing quality. Control group not eligible for intervention

ContaminationUnclear riskCannot tell

Baseline responseHigh riskRepresentative population and 49% baseline response

Implementation of interventionLow riskMinimal variation in intervention across sample

Wells 2000

MethodsUncontrolled before and after


ParticipantsFamilies on fringe of home-ownership, in need of improved housing and willing to enter commitment of housing partnership including mortgage contributions. 74% female head of household; family size 2 to 8 persons. Mean income/month $1,396, mean income to needs ratio=1.10 (1.0=poverty line). Ethnicity: 61% African-American, 37% White; mean age 33 years


InterventionsRehousing or retrofitting with or without neighbourhood renewal (after 1995)


OutcomesPsychological well-being (instrument - PERI - Psychiatric Epidemiology Research Instrument for non-clinical populations - 21 item).


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)High riskUncontrolled before and after

Allocation concealment (selection bias)High riskUncontrolled before and after

Blinding of participants and personnel (performance bias)
Health
High riskNo control group

Blinding of outcome assessment (detection bias)
Health
High riskNo control group

Blinding of analystsHigh riskNo control group

Incomplete outcome data (attrition bias)
Health
Unclear riskReasons for withdrawals reported unclear if related to final outcome

Selective reporting (reporting bias)Unclear riskNo protocol available

Baseline outcome characteristics similarHigh riskNo control group

Baseline characteristics similarHigh riskNo control group

ContaminationHigh riskNo control group

Baseline responseHigh riskTarget population, small selected sample, and baseline response unclear

Implementation of interventionLow riskMinimal variation in intervention across sample

Wilner 1960

MethodsControlled before and after


ParticipantsBlack families living in slum areas


InterventionsRehousing from slums (before 1970)


OutcomesSelf-reported illness episodes, positive mood, nervousness, morale, optimism/pessimism. Income and affordability, social contact and relationships within the household and beyond.


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)High riskControlled before and after

Allocation concealment (selection bias)High riskControlled before and after

Blinding of participants and personnel (performance bias)
Health
Unclear riskNo report of blinding of study participants or personnel

Blinding of outcome assessment (detection bias)
Health
Unclear riskNo report of blinding of outcome assessors

Blinding of analystsUnclear riskNo report of blinding of data analysts

Incomplete outcome data (attrition bias)
Health
Unclear riskNo indication of missing data for individual outcomes

Selective reporting (reporting bias)Unclear riskNo protocol available

Baseline outcome characteristics similarUnclear riskSimilar health outcomes at baseline but data unclear

Baseline characteristics similarUnclear riskData indicates similar socio-demographic data and housing quality. Control group not eligible for housing improvement

ContaminationUnclear riskCannot tell

Baseline responseUnclear riskSomewhat representative population and 79% baseline response

Implementation of interventionLow riskMinimal variation in intervention across sample

 
Characteristics of excluded studies [ordered by study ID]

StudyReason for exclusion

Aiga 2002Direct health outcome assessed but no assessment of change following intervention

Allen 2011Air quality interventions not eligible for inclusion, and included in another Cochrane review. See  Excluded studies 'Results' section

Bailie 2012Unclear what housing improvement comprised and who in the sample received it. Estimated <17% in receipt of intervention

Burr 2007Air quality interventions not eligible for inclusion, and included in another Cochrane review. See  Excluded studies 'Results' section

Butala 2010Case control study

Caldwell 2001No data reported for direct health outcomes

Cattaneo 2007Direct health outcome assessed but no assessment of change following intervention

Choudhary 2002Direct health outcome assessed but no assessment of change following intervention

Coggon 1991Case control study

Eick 2011Data unclear for intervention included in the review

El Ansari 2008Area level data, unclear proportion exposed to housing improvement

Ferguson 1954Direct health outcome assessed but no assessment of change following intervention

Green 1999Direct health outcome assessed but no assessment of change following intervention

Heyman 2011No data reported for direct health outcomes

Jackson 2011Health service use outcomes only and no baseline data

Jones 1999Case control study

Kahlmeier 2001Participants not part of discrete housing improvement intervention

Keatinge 1989Case control study

Kovesi 2009Air quality interventions not eligible for inclusion, and included in another Cochrane review. See Excluded studies 'Results' section

Marsh 1999Retrospective analysis - participants not part of discrete housing improvement programme

Meddings 2004Case control study

Pholeros 1993No direct health outcomes reported - health service use data only

Roder 2008No data reported for direct health outcomes

Sedky 2001Direct health outcome assessed but no assessment of change following intervention

Smith 1997Direct health outcome assessed but no assessment of change following intervention

Telfar-Barnard 2011Direct health outcome assessed but no assessment of change following intervention

Vyas 1998Insufficient information available - author contacted but no response

Walker 1999No direct health outcomes reported - health service use data only

Wambem 1973No direct health outcomes reported - health service use data only

Warm Front 2008Direct health outcome assessed but no assessment of change following intervention

Warner 2000Air quality interventions not eligible for inclusion, and included in another Cochrane review. See  Excluded studies 'Results' section

Westaway 2007Unclear if intervention eligible - author contacted but no response

Winder 2003No data reported for direct health outcomes

Wolff 2001Direct health outcome assessed but no assessment of change following intervention

Woodin 1996No direct health outcomes reported- health service use data only

Wright 2009Air quality interventions not eligible for inclusion, and included in another Cochrane review. See  Excluded studies 'Results' section

 
Characteristics of studies awaiting assessment [ordered by study ID]
Decent Homes 2012

MethodsQualitative interviews

ParticipantsSocial housing tenants

InterventionsWarmth improvements

OutcomesOpen ended

Notes

Ellaway 2000

MethodsQualitative interviews

ParticipantsSocial housing tenants

InterventionsRehousing or refurbishment

OutcomesOpen ended

Notes

 
Characteristics of ongoing studies [ordered by study ID]
GoWell

Trial name or titleGoWell

MethodsCross sectional Controlled Before & After with some longitudinal follow-up over 10 years

ParticipantsResidents of deprived neighbourhoods in Glasgow, predominantly social housing tenants

InterventionsMajor neighbourhood and housing investment

OutcomesSF-12 and multiple measures of wellbeing

Starting date2006

Contact informationAde Kearns (Principal Investigator) a.kearns@lbss.gla.ac.uk

Notes

Lyons 2011

Trial name or titleHealth impact, and economic value, of meeting housing quality standards

MethodsControlled before and after using routine data

ParticipantsSocial housing tenants (>20,000 households)

InterventionsHousing-led neighbourhood regeneration

OutcomesWell-being and health service use

Starting date2011

Contact informationr.a.lyons@swansea.ac.uk

Notes

WHEZ

Trial name or titleWarm Homes for Elder New Zealanders

MethodsRandomised controlled trial

ParticipantsAdults over 55 years with diagnosed chronic obstructive pulmonary disease (COPD) who reported an exacerbation in the last 3 years, or who have 'moderate' (or worse) COPD

InterventionsThe participants are randomised to receive a fuel voucher/subsidy (NZ $500). Participants will also have their house insulated if necessary and feasible

OutcomesModerate exacerbations of COPD that are treated with systemic corticosteroids and/or antibiotics. Severe exacerbations of COPD for which hospitalisation is required

Starting date2008

Contact informationWHEZ

Notes

 
Comparison 1. Standardized effect estimates for self-reported health following warmth and energy efficiency improvements (post-1985)

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Poor/fair self-reported health1Odds Ratio (Random, 95% CI)0.59 [0.47, 0.74]

 2 Poor/fair self-reported health (children)1Odds Ratio (Random, 95% CI)0.48 [0.31, 0.74]

 
Comparison 2. Standardized effect estimates for respiratory outcomes following warmth and energy efficiency improvements (post-1985)

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Experimental studies3Odds Ratio (Random, 95% CI)Subtotals only

    1.1 Sleep disturbed by wheeze (children)
2Odds Ratio (Random, 95% CI)0.56 [0.43, 0.74]

    1.2 Speech disturbed by wheeze (children)
2Odds Ratio (Random, 95% CI)0.59 [0.41, 0.85]

    1.3 Dry cough at night (children)
1Odds Ratio (Random, 95% CI)0.52 [0.32, 0.85]

    1.4 Wheeze during exercise (children)
1Odds Ratio (Random, 95% CI)0.67 [0.42, 1.07]

    1.5 Wheeze in past 3 months (children & adults)
1Odds Ratio (Random, 95% CI)0.57 [0.47, 0.70]

    1.6 Morning phlegm
1Odds Ratio (Random, 95% CI)0.64 [0.52, 0.78]

    1.7 Cold or flu (children & adults)
1Odds Ratio (Random, 95% CI)0.54 [0.43, 0.69]

    1.8 Asthma (children & adults)
1Odds Ratio (Random, 95% CI)0.95 [0.60, 1.50]

    1.9 Bronchitis (children & adults)
1Odds Ratio (Random, 95% CI)1.01 [0.48, 2.13]

    1.10 Other respiratory symptoms (children & adults)
1Odds Ratio (Random, 95% CI)1.01 [0.56, 1.82]

 2 Non-experimental studies3Odds Ratio (Random, 95% CI)Subtotals only

    2.1 Ever diagnosed nasal allergy
1Odds Ratio (Random, 95% CI)1.52 [1.05, 2.20]

    2.2 Ever diagnosed bronchitis
1Odds Ratio (Random, 95% CI)1.29 [0.97, 1.72]

    2.3 Ever diagnosed asthma
1Odds Ratio (Random, 95% CI)0.92 [0.63, 1.34]

    2.4 Asthma
1Odds Ratio (Random, 95% CI)0.57 [0.10, 3.26]

    2.5 Chest infection/bronchitis
1Odds Ratio (Random, 95% CI)1.87 [0.50, 7.10]

    2.6 Pneumonia/hypothermia
1Odds Ratio (Random, 95% CI)3.59 [0.14, 90.28]

    2.7 Persistent cough (children)
1Odds Ratio (Random, 95% CI)0.97 [0.44, 2.15]

    2.8 Wheezing (children)
1Odds Ratio (Random, 95% CI)1.13 [0.47, 2.71]

    2.9 Runny nose (children)
1Odds Ratio (Random, 95% CI)0.69 [0.34, 1.40]

 
Comparison 3. Standardized effect estimates for mental health outcomes following warmth and energy efficiency improvements (post-1985)

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Experimental studies1Odds Ratio (Random, 95% CI)Subtotals only

    1.1 Low happiness (SF-36)
1Odds Ratio (Random, 95% CI)0.56 [0.41, 0.77]

    1.2 Low vitality (SF-36)
1Odds Ratio (Random, 95% CI)0.51 [0.41, 0.64]

 2 Non-experimental studies3Odds Ratio (Random, 95% CI)Subtotals only

    2.1 Depression
1Odds Ratio (Random, 95% CI)1.40 [0.33, 5.99]

    2.2 Stress/Mental illness
1Odds Ratio (Random, 95% CI)0.26 [0.05, 1.29]

    2.3 Feeling down (children)
1Odds Ratio (Random, 95% CI)0.66 [0.23, 1.89]

    2.4 Temper tantrums (children)
1Odds Ratio (Random, 95% CI)0.97 [0.44, 2.15]

    2.5 Irritability (children)
1Odds Ratio (Random, 95% CI)1.54 [0.57, 4.20]

 
Comparison 4. Standardized effect estimates for illness and symptom outcomes following warmth and energy efficiency improvements (post-1985)

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Experimental studies2Odds Ratio (Random, 95% CI)Subtotals only

    1.1 Diarrhoea (children)
1Odds Ratio (Random, 95% CI)0.72 [0.45, 1.15]

    1.2 Ear infection (children)
1Odds Ratio (Random, 95% CI)1.16 [0.68, 1.98]

    1.3 Vomitting (children)
1Odds Ratio (Random, 95% CI)0.88 [0.55, 1.41]

    1.4 Twisted ankle (children)
1Odds Ratio (Random, 95% CI)1.86 [1.03, 3.36]

    1.5 Arthritis (children & adults)
1Odds Ratio (Random, 95% CI)1.06 [0.53, 2.10]

    1.6 Rheumatism (children & adults)
1Odds Ratio (Random, 95% CI)1.91 [0.83, 4.39]

 2 Non-experimental studies3Odds Ratio (Random, 95% CI)Subtotals only

    2.1 Ever diagnosed hypertension
1Odds Ratio (Random, 95% CI)0.77 [0.61, 0.97]

    2.2 Ever diagnosed heart disease
1Odds Ratio (Random, 95% CI)0.69 [0.52, 0.92]

    2.3 Ever diagnosed circulation problem
1Odds Ratio (Random, 95% CI)1.06 [0.83, 1.35]

    2.4 Ever diagnosed eczema
1Odds Ratio (Random, 95% CI)1.43 [0.89, 2.30]

    2.5 "Other" Illnesses
1Odds Ratio (Random, 95% CI)0.57 [0.10, 3.26]

    2.6 Arthritis
1Odds Ratio (Random, 95% CI)1.62 [0.34, 7.64]

    2.7 Angina
1Odds Ratio (Random, 95% CI)0.20 [0.04, 0.98]

    2.8 Aches & pains (children)
1Odds Ratio (Random, 95% CI)1.54 [0.66, 3.56]

    2.9 Diarrhoea (children)
1Odds Ratio (Random, 95% CI)0.73 [0.25, 2.13]

    2.10 Earache (children)
1Odds Ratio (Random, 95% CI)0.98 [0.35, 2.75]

    2.11 Fever (children)
1Odds Ratio (Random, 95% CI)0.78 [0.33, 1.87]

    2.12 Headaches (children)
1Odds Ratio (Random, 95% CI)0.68 [0.23, 1.99]

    2.13 Poor appetite (children)
1Odds Ratio (Random, 95% CI)0.34 [0.15, 0.80]

    2.14 Sore throat (children)
1Odds Ratio (Random, 95% CI)1.35 [0.67, 2.75]

    2.15 Vomiting (children)
1Odds Ratio (Random, 95% CI)0.96 [0.38, 2.44]

    2.16 Tiredness (children)
1Odds Ratio (Random, 95% CI)1.52 [0.64, 3.61]

 
Comparison 5. Standardized effect estimates for general health outcomes following rehousing or retrofitting with or without neighbourhood renewal (post-1995) (non-experimental studies)

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Poor/fair self-reported health3Odds Ratio (Fixed, 95% CI)Subtotals only

 2 Long standing illness1Odds Ratio (Random, 95% CI)0.68 [0.44, 1.05]

 3 Health not improved/worse since one year ago2Odds Ratio (Random, 95% CI)0.60 [0.29, 1.26]

 4 Health interferes with daily activities1Odds Ratio (Random, 95% CI)1.52 [0.62, 3.73]

 5 Lower Physical Component score (SF-36)1Odds Ratio (Random, 95% CI)0.96 [0.44, 2.11]

 6 Physical or emotional problems with daily life in past month1Odds Ratio (Random, 95% CI)0.34 [0.14, 0.83]

 
Comparison 6. Standardized effect estimates for respiratory health outcomes following rehousing or retrofitting with or without neighbourhood renewal (post-1995) (non-experimental studies)

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Wheezing in past year1Odds Ratio (Random, 95% CI)1.04 [0.69, 1.57]

 2 Asthma (children)1Odds Ratio (Random, 95% CI)1.04 [0.65, 1.66]

 3 Breathlessness (children)1Odds Ratio (Random, 95% CI)1.18 [0.46, 3.06]

 4 Persistent cough (children)1Odds Ratio (Random, 95% CI)1.09 [0.66, 1.80]

 5 Bronchitis (children)1Odds Ratio (Random, 95% CI)0.31 [0.03, 3.02]

 6 Sinus/Cattarh (children)1Odds Ratio (Random, 95% CI)0.89 [0.48, 1.65]

 
Comparison 7. Standardized effect estimates for mental health outcomes following rehousing or retrofitting with or without neighbourhood renewal (post-1995) (non-experimental studies)

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Lower mental component score (SF-36)1Odds Ratio (Random, 95% CI)0.73 [0.33, 1.61]

 2 Anxiety/depression (self-reported)1Odds Ratio (Random, 95% CI)0.36 [0.15, 0.86]

 
Comparison 8. Standardized effect estimates for other health related outcomes following rehousing or retrofitting with or without neighbourhood renewal (post-1995) (non-experimental studies)

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Smoker1Odds Ratio (Random, 95% CI)1.47 [0.85, 2.55]

 2 Heavy drinker1Odds Ratio (Random, 95% CI)0.61 [0.30, 1.24]

 3 < 5 portions of fruit/veg per day1Odds Ratio (Random, 95% CI)0.79 [0.52, 1.21]

 4 Chronic illness (children)1Odds Ratio (Random, 95% CI)1.04 [0.55, 1.97]

 5 Headaches (children)1Odds Ratio (Random, 95% CI)0.99 [0.60, 1.63]

 6 Indigestion (children)1Odds Ratio (Random, 95% CI)0.94 [0.06, 15.27]

 7 Sleeping problems (children)1Odds Ratio (Random, 95% CI)1.13 [0.62, 2.06]

 8 Eczema (children)1Odds Ratio (Random, 95% CI)1.15 [0.68, 1.93]

 9 Hay fever (children)1Odds Ratio (Random, 95% CI)0.99 [0.51, 1.91]

 10 Pain & discomfort1Odds Ratio (Random, 95% CI)0.40 [0.17, 0.94]

 11 Limitations to mobility1Odds Ratio (Random, 95% CI)0.53 [0.22, 1.32]

 
Comparison 9. Standardized effect estimates for mental health outcomes following rehousing from slums (pre-1975) (non-experimental studies)

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Nervousness1Odds Ratio (Random, 95% CI)1.16 [0.89, 1.50]

 2 Negative mood1Odds Ratio (Random, 95% CI)0.91 [0.70, 1.18]

 3 Dissatisfaction with status quo1Odds Ratio (Random, 95% CI)0.86 [0.66, 1.12]

 4 Potency (nothing can be done to improve situation)1Odds Ratio (Random, 95% CI)0.81 [0.63, 1.06]

 5 Pessimism1Odds Ratio (Random, 95% CI)0.81 [0.63, 1.06]

 6 Emotionality (unable to control temper)1Odds Ratio (Random, 95% CI)0.80 [0.61, 1.03]

 
Comparison 10. Standardized effect estimates for disability following rehousing from slums (pre-1975) (non-experimental studies)

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 At least one day of disability1Odds Ratio (Random, 95% CI)1.14 [0.98, 1.34]

 
Table 1. Details of excluded studies (n=36) (ordered by intervention category and alphabetically)

Author,  publication year, country,Study design, final sample sizeIntervention summaryReason for exclusion




Warmth and energy efficiency improvements (after 1980)

Caldwell 2001,

UK
Controlled before & after

Final/Baseline sample: 412/929 (43%)
Thermal improvements according to need, they included heating, windows, cavity wall, insulation, fabric repair, re-roofing, loft insulation, external cladding, re-rendering, controlled entry, humidistat fans, close painting, new, balcony rail, new doors, rewiring, new flooring, backcourt lighting.No health outcome data reported, health service use only




El Ansari 2008, 2008, UKCross-sectional controlled before & after (routine data)Assessment for eligibility for warmth grant- unclear what improvements implementedArea level data, unclear proportion exposed to housing improvement




Warm Front 2008,

UK
Retrospective cross sectional controlled

Final sample: 2180 indivduals
Grants for insulation (cavity wall and/or loft) draught proofing, hot water tank jacket , and/or central heating, and minor measures, heating repair, energy efficient light bulbs, security measures  (up to total value of £2,700)Direct health outcome assessed but no assessment of change following intervention




Green 1999

UK
Retrospective controlled

Final sample: 205 households
Replacement of underfloor electric heating with a small gas-fired central heating plant piping hot water to each apartment, improved insulation, each towerblock was encased in a mineral wool insulation material, with an outer skin of rainscreen cladding using an aluminium cassette-type system. Open balconies were enclosed with glass, new ventilation system to replace vitiated air and remove moisture laden air while minimising heat loss and avoiding draughts.  Plus substantial improved security measures.Direct health outcome assessed but no assessment of change following intervention




Heyman 2011,

UK
Randomised controlled trial

Final/Baseline sample:140/237 (59%)
Loft insulation (54%), cavity wall insulation (53%), draught exclusion (29%), heating controls (20%), central heating (13%), and other measures (not specified).No data reported




Jackson 2011,

New Zealand
Cross sectional controlled before & after

Final sample: 9,702
Insulation (26.5%) & ventilation (43.5%) improvements, improved heating system (4.4%), extensions (8.7%), plus housing and health advice, improved links with health and other support agenciesHealth service use only




Jones 1999, UKCase controlNo discrete programme of housing improvement: moving house and changes in heating systemCase control study




Keatinge 1989, UKCase controlNo discrete programme of housing improvement: use of domestic heatingCase control study




Roder 2008, CanadaRetrospective uncontrolled

Final/Baseline sample: 26/9 (34.5%)
Energy Effciency using "Green indicators" - size according to occupational requirements; heating and cooling efficiency, indoor air quality and resource efficiency (water, electricity).No data reported




Telfar-Barnard 2011. New ZealandRetrospective controlled

Final sample: 973,710 individuals
Funding for insulation retrofits and clean, efficient heating grantsDirect health outcome assessed but no assessment of change following intervention




Winder 2003, UKUncontrolled before & after

Final/Baseline sample: 72/210 (34.3%)
Installation of central heating and insulation measures for elderly (70+ years)No data reported




Rehousing/refurbishment +/- neighbourhood regeneration/relocation

Smith 1997, UKRetrospective controlled

Final sample: 538 individuals

 
Medical priority rehousingDirect health outcome assessed but no assessment of change following intervention




Walker 1999, UKCross sectional controlled before & after

Final sample: 2 primary care practices with reference practices
Housing led neighbourhood regeneration.  Homes renovated with additional improvement to physical and social neighbourhood environment.Health service use only




Woodin 1996, UKRetrospective uncontrolled

Final sample: 112 households.
Mix of neighbourhood and housing renewal. Original housing demolished and replaced with new stock.Health Service use only




Provision of basic housing needs/low or middle income country intervention

Sedky 2001, PakistanCross-sectional controlled before & after

Final sample: 1,359
Installation of roof hatch windows, wall and roof insulation, double glass windows, stove with water warming facilityDirect health outcome assessed but no assessment of change following intervention




Aiga 2002, PhilippinesCross-sectional controlled before & after

Final/Baseline sample: 370/402 (92%) households
Provision of private water faucet (with meter) and private toilet, electricity, paved roadways to every household.Direct health outcome assessed but no assessment of change following intervention




Bailie 2012, AustraliaUncontrolled before & after

Final sample: 418 children
Unclear. New houses built in each community, mean 10 new houses in each community of around 66 houses. Study sample does not distinguish between those living in new houses and those who are not.Unclear what housing intervention comprised and who received it, less than 17% sample received intervention




Butala 2010, IndiaCase control

Final sample: unclear
No discrete programme of housing improvementDirect health outcome assessed but no assessment of change following intervention




Cattaneo 2007, MexicoRetrospective controlled

Final sample: 2783 households
Replacing mud floors (up to 50sqm) with cement floors.Direct health outcome assessed but no assessment of change following intervention




Choudhary 2002, IndiaRetrospective controlled

Final/Baseline sample: 365/373 (98%)
Provision of plot for families previously living in temporary shanty town housing to build own house. Involved relocation to non-shanty area nearby- new houses built were permanent structures of brick & cementDirect health outcome assessed but no assessment of change following intervention




Meddings 2004, AfghanistanCase control

Final sample 1863 individuals
No discrete programme of housing improvement: latrine improvementCase control study




Pholeros 1993, AustraliaCross-sectional uncontrolled before & after

Final sample: area clinic data n=71 records, 11 houses in study area
Repair and maintenance training in relation to health hardware in house (power, water, cleaning, dust control).  Included installation of showers, electrical upgrades, stove replacement, promoting healthy living practices (washing people/clothes, removing waste, improving nutrition, reducing overcrowding, separating dogs and children, controlling dust, temperature control, reducing trauma/accidents).  Also provision of shampoo/soap, nutritional programme.

Outdoor housing conditions: fences around houses, stress, improvement to wet area outside house.  Different aspects of the improvements were carried out through out the year (i.e. not all at once).  Some people may have been rehoused (unclear).
Health service use only




Wolff 2001, MalawiCross sectional controlled before & after

Final sample: 529
Rehousing from 2 room traditional mud house with thatched roof and hard packed mud floors to 3 room house with fired mud bricks, tiled roof, concrete foundation (10 year interest free loan to buy house US$550/UK£370). New houses built by householder and other community members.Direct health outcome assessed but no assessment of change following intervention




Vyas 1998, India

 
Case study

Final sample unclear
Case study of a “Habitat Improvement Programme”Insufficient information available- author contacted but no response




Rehousing from slums (before 1970)

Ferguson 1954, UKRetrospective cross-sectional controlled

Final sample: 1,106 households
Rehousing slum dwellers to new build, vermin free housing with own water supply.  56% of new houses had sole use of lavatory.Direct health outcome assessed but no assessment of change following intervention




Wambem 1973, USACross-sectional controlled before & after

Final sample: 107 individuals
Rehoused from sub-standard wooden framed housing in serious need of repair with inadequate sewage and solid waste disposal to new build public housing in planned housing project.  New houses were of stucco construction set on landscaped grounds, with paved streets, sidewalks and street lighting,  have gas heat and modern kitchens, plumbing and sewage facilities, weekly refuse removal.Health Service use only




Other categories

Burr 2007, UKRandomised controlled trial

Final sample: 182 indidivudals
Mould removal with fungicide and installation of positive input ventilation fan installed in loft of houseExcluded intervention




Allen 2011, CanadaRandomised controlled crossover trial

Final sample: 45 individuals (25 households)
Portable air filtersExcluded intervention




Coggon 1991, UK

 
Case control study

Final sample: 1865 individuals
No discrete programme of housing improvement: sanitary improvementsCase control study




Eick 2011, UKRandomised controlled trial

Final sample: 49 households (withdrawals unclear).
Mechanical Ventilation Heat Recovery (MVHR), also central heating. Data only reported for MVHR.Excluded intervention




Kahlmeier 2001, SwitzerlandRetrospective uncontrolled

Final sample: 3870 individuals
No discrete programme of housing improvement: house moveParticipants not part of discrete housing improvement intervention




Kovesi 2009, CanadaRandomised controlled trial

Final sample: 1344 individuals
Installation of mechanical ventilation and heat recoveryExcluded intervention




Marsh 1999, UKLongitudinal lifecourse survey data

Final sample: 9848 individuals
No discrete programme of housing improvement: house moveRetrospective analysis- participants not part of discrete housing improvement programme




Warner 2000, UKRandomised controlled trial

Final sample: <40 households
Installation of mechanical ventilation and heat recoveryExcluded intervention




Westaway 2007, South AfricaUnclear design & sample

Baseline sample ˜371 individuals
UnclearInsufficient information available- author contacted but no response




Wright 2009, UKRandomised controlled trial

Final sample: 101 individuals
Installation of mechanical ventilation and heat recovery systemsExcluded intervention

 
Table 2. Summary of quality assessment of qualitative studies (ordered by intervention category and publication year)

Author, Country, YearSample SizeAre the research questions clear?Are the research questions suited to qualitative enquiry?Are the following described?Are the following appropriate to the research question?Are the claims made supported by sufficient evidence?Does the paper make a useful contribution?








    SamplingData CollectionAnalysisSamplingData CollectionAnalysis  

Warmth and energy efficiency improvements (after 1980)

Basham et al, UK, 2004

 

Supplementary to quantitative data (Barton 2007, included in synthesis)
12- also interviewed pre interventionYesYesYesYesYesYesYesYesYesYes

Caldwell et al, UK, 2001

 

Supplementary to quantitative data (Caldwell 2001, excluded from synthesis)
6 focus groups- total numbers not reportedYesYesUnclearYesNoUnclearYesUnclearYesYes

Gilbertson et al, UK, 2006

 

Supplementary to quantitative data (Warm Front 2008, excluded from synthesis)
49 households + 16 refusalYesYesYesYesYesYesYesYesYesYes

Harrington et al, UK, 2005

 

Supplementary to quantitative data (Heyman 2001, excluded from synthesis)
30  (only 17/30 had intervention- all 17 in fuel poverty prior to intervention)YesYesYesYesYesYesYesYesYesYes

Rugkasa et al, Ireland, 2004

 

Supplementary to quantitative data (Shortt, 2007, included in synthesis)
9 + focus groupYesYesYesYesYesYesYesYesYesYes

Rehousing or retrofitting with or without neighbourhood renewal (after 1995)

Bullen, New Zealand, 2008

 

Supplementary to quantitative data (Jackson 2011, excluded from synthesis)
30 interviews with householders, also 19 interviews with housing providersYesYesYesYesYesYesYesYesYesYes

Ellaway et al, UK, 2000

 

Qualitative data only
28 (16 improved, 12 unimproved flats)YesYesNoYesNoUnclearYesUnclearYesYes

Gibson et al, UK, 2011

 

Supplementary to quantitative data (Kearns 2008, included in synthesis)
22/60 contactedYesYesYesYesYesUnclearYesYesYesYes

Rogers, UK, 2008

 

Supplementary to quantitative data (Thomas, 2005, included in synthesis)
20 in depth interviews, and 200 brief interviewsYesYesYesYesYesYesYesYesYesYes

Studies excluded from synthesis due to poor quality of data

Warmth and energy efficiency improvements (after 1980)

Decent Homes, UK, 2012

 

Qualitative data only
6NoUnclearNoNoNoUnknownUnclearUnclearUnclearNo

Allen, UK, 2005

 

Supplementary to quantitative data (Allen 2005a, included in synthesis)
16NoUnclearNoYesNoUnclearYesUnclearYesUnclear

Rehousing or retrofitting with or without neighbourhood renewal (after 1995)

Kearns et al, UK, 2006

 

Supplementary to quantitative data (Kearns 2008, included in synthesis)
28NoUnclearNoYesNoUnclearYesUnclearYesUnclear

 
Table 3. Summary of reported qualitative data and study characteristics (ordered by intervention category and year of publication)

Author, Publication Year, Country, ReferenceSampleData collection methods and details of interventionOverview of findings:

 

Intervention Category:  Warmth and energy efficiency improvements (after 1980)

Basham et al, 2004,

UK

 

Supplementary to quantitative data (Barton, 2007, included in synthesis)

 
Aim of qualitative data: 1.  To promote understanding of the wider social issues of living in cold households and then warmer ones by assessing:  energy use, methods of payments and costs; use of the house, the well-being of residents and relationships within the household and beyond; respondents’ perception of their dwelling and area.

2.  To provide evidence to inform housing improvement strategy by assessment of: the factors influencing energy use of the household; residents’ knowledge of how to operate the heating system efficiently and effectively, and their perception of the importance of ventilation to the indoor environment.

 

Sample Selection: Sub-sample of housing project where people who had no central heating now had it installed

 

Sample Size: 12- also interviewed pre intervention

 

Description of intervention: Warmth- central heating

 

Time since intervention: 1-6 months
 

 

Data collection method:

In-depth interviews

 

Details of analysis:

Grounded theory- thematic analysis

 

Year of interviews: 2002-2003

 

 
Householders reported using more of the house which was warmer and drier. Cost remained an issue but varied in importance. Opportunities for leisure and study improved, there was increased motivation to maintain the house and this resulted in more social interaction. There was a perceived improvement in relationships and health. There were also issues around the communication between householders, contractors and housing managers: information on the new systems was variable, the relationship between tenants and contractors reflected the residents’ status as tenants.

Caldwell et al, 2001,

UK

 

Supplementary to quantitative data (Caldwell 2001, excluded from synthesis)

 
Aim of qualitative data: To gather data on residents attitudes and feelings

 

Sample Selection: Randomly from list of intervention and control groups by local authority

 

Sample Size: 6 focus groups- total numbers not reported

 

Description of intervention: Warmth measures- varied depending on baseline condition of house

 

Time since intervention: 2-4 years
 

 

Data collection method:

Focus groups

 

Details of analysis:

Not reported

 

Year of interviews: 1998

 

 
Residents pleased with improvements. Improved view of home, increased use of space due to warmth, improved family relationships, increased feelings of privacy due to increased usable space.  Some reports of better quality of diet, explained partly by more money available for food (presumably related to increased fuel efficiency and reduced fuel bills but not clearly stated- quantitative data reports significant reductions in fuel bills among intervention group) and kitchen improved and people more inclined to spend time in kitchen preparing food.  Residents in the control group reported feeling let down, resentful, tense and stressed but were hopeful that they would benefit from similar improvements soon.  For both groups other problems remained such as the need for improvements to the neighbourhood and immediate external housing environment was reported.  Feelings of insecurity included issues such as threat of crime, violence and drugs.

Gilbertson et al, 2006,

UK

 

Supplementary to quantitative data (Warm Front 2008, excluded from synthesis)

 
Aim of qualitative data: Assess change in householder's perceptions and behaviours following intervention, satisfaction with intervention, perceived changes in health and well-being, changes in use of living space and social interaction.

 

Sample Selection: Purposive to represent 5 intervention areas, half with family member 60+ yrs; half with children under 16yrs.  All had high level intervention i.e. installation/upgrade of heating or insulation.

 

Sample Size: 49 households + 16 refusal

 

Description of intervention: Warmth- Insulation and heating installation/upgrade

 

Time since intervention: About a year
 

 

Data collection method:

Semi-structured interviews carried out by 4 interviewers

 

Details of analysis:

Grounded theory- thematic analysis checked and agreed by co-interviewers

 

Year of interviews: 2003

 

 
Most householders reported improved and more controllable warmth and hot water.  Many also reported improved physical health and comfort, especially of mental health and emotional well-being and, in several cases, the easing of chronic illness symptoms.  There were reports of improved family relations, an expansion of the domestic space used during winter months, greater use of kitchens and improved nutrition, increased privacy, improved social interaction, and an increase in comfort and atmosphere within the home. Greater warmth and comfort also enhanced emotional security, and recipients were more content and at ease in their homes.  There was little evidence of substantially reduced heating bills.  Authors conclude:  Intervention was accompanied by appreciable benefits in terms of use of living space, comfort and quality of life, physical and mental well-being, although there is only limited evidence of change in health behaviour.   Some reports (around quarter of residents) reported long term negative effects of disruption, lack of control/powerlessness over move and what was done to their house.  Most residents (around 2/3) found reported disruption and lack of control and found it tolerable and short lived.

Harrington et al, 2005,

UK

 

Supplementary to quantitative data (Heyman 2011, excluded from synthesis)

 
Aim of qualitative data: Explore experiences and nature of fuel poverty and relationship to health, and responses to fuel poverty interventions

 

Sample Selection: Random selection- 10 refusals

 

Sample Size: 30  (only 17/30 had intervention- all 17 in fuel poverty prior to intervention)

 

Description of intervention: Warmth- Tailored intervention to alleviate fuel poverty- loft insulation, cavity wall insulation, draught exclusion, central heating and other measures (average £727, up to £3335)

 

Time since intervention: 6-9 months
 

 

Data collection method:

Semi-structured interviews

 

Details of analysis:

Grounded theory- descriptive open coding

 

Year of interviews: 2000-2002

 

 
Some respondents were unable to comment on the benefits of the intervention as they had not experienced a winter with the intervention.  Suggestion from quantitative data that benefits of intervention were in reduced fuel bills rather than in increased warmth.  Some reports in qualitative data that the intervention increased the effective size of the living area during cold weather.  Authors conclude that fuel poor households may assume that heating systems are costly and inefficient and attention is directed towards living with heating system insufficiency.  Better understanding of the supply side (of the benefits of cavity wall insulation and of how to use heating controls) would allow the same limited resource to go further.

Rugkasa et al, 2004,

Ireland

 

Supplementary to quantitative data (Shortt, 2007, included in synthesis)

 
Aim of qualitative data: To further explore how the intervention impacted on residents' lives asking about subjects not raised in the quantitative survey

 

Sample Selection: Only those with the full intervention

 

Sample Size: 9 + focus group

 

Description of intervention: Warmth- heating/insulation upgrade/installation

 

Time since intervention: 1-3.5 years

 
 

 

Data collection method:

In-depth interview and one focus group

 

Details of analysis:

Content and thematic analysis- 'data validation followed established academic procedures'

 

Year of interviews: 2003

 

 
High levels of satisfaction with intervention.  Homes now easier to heat especially for older people who previously found it physically difficult to carry coal.  People enjoyed warm home and some reports of this making people feel better mentally and physically.

Intervention Category:  Rehousing/refurbishment +/- neighbourhood regeneration +/- relocation

Bullen, 2008,

New Zealand

 

Supplementary to quantitative data (Jackson 2011, excluded from synthesis)

 
Aim of qualitative data: Investigate how housing providers and householders responded to an intervention that addresses the dynamism of the physical and social aspects of housing

 

Sample Selection: Criteria used to select sample to allow comparisons of location, extent & time since intervention- unclear if this was achieved, 24/30 households were known as "successful intervention" cases

 

Sample Size: 30 interviews with householders, also 19 interviews with housing providers

 

Description of intervention: Insulation, ventilation, heating, or extension to existing house or new house; referral to health and social agencies

 

Time since intervention: Between 1 and 6 years
 

 

Data collection method:

In-depth interviews by ethnically matched interviewer

 

Details of analysis:

Inductive analysis to identify and compare emergent themes by location, extent and time since intervention

 

Year of interviews: 2004-2007

 

 
Most participants, even those with the minimal insulation/ventilation intervention, reported improvements in health and wellbeing.  Most commonly there was an increased sense of empowerment, reduction in illnesses (in particular asthma), improved comfort in the home, improved family functioning and a heightened sense of social wellbeing. The strongest link between the programme and  health was reduced stress, increased happiness and increased connection with family.  Reports of improved wellbeing were linked to tangible housing improvements in particular additional space and improved thermal comfort. Those who had benefited from structural changes and increased space reported the greatest benefits, in particular improved family relations, privacy, a more peaceful environment, reduced household mess and increased house pride.  There were also reports of increased ability to invite people into their own homes to socialise.  Increased space outside was reported to provide safe play areas for children, and there was some suggestion that the improved indoor environment facilitated studying/completing homework for both school children and adults. 

 

These positive impacts on family functioning and daily life were linked by residents to improvements in psycho-social wellbeing.  For residents with disability needs homes were redesigned to facilitate wheelchair- this was reported to make a big difference to those residents. 

 

Obstacles reported by residents to limit the potential benefit were: poor quality modifications, inadequate warmth improvement, increased housing costs (due to increased housing size- rent & fuel bills), inadequate drainage and fencing in outdoor areas.

 

Additional data available in two earlier reports reflect the findings reported in this paper.

Ellaway et al, 2000,

UK

 

Qualitative data only

 
Aim of qualitative data: Explore residents views of the possible health impact of  recent housing improvements

 

Sample Selection: Volunteers selected by housing agency

 

Sample Size: 28 (16 improved, 12 unimproved flats)

 

Description of intervention: Refurbished tenemental flats, new build terrace/semi-detached housing

 

Time since intervention: 2-7 years
 

 

Data collection method:

Interview

 

Details of analysis:

Not reported

 

Year of interviews: 1999

 

 
Tenants in improved/new housing reported reduced coughs and use of inhalers among children, and less use of tranquilisers, reduced smoking and improved diet.  Also reported that they felt better about life and had more money available due to reduced fuel bills.  Other reports of links between housing and health included issues of drug users living next door and the general quality of the local environment as well as indoor housing conditions.

Gibson et al, 2011,

UK

 

Supplementary to quantitative data (Kearns 2008, included in synthesis)

 
Aim of qualitative data: To explore the impacts of housing and area change on a range of health, community, and social outcomes from the perspectives of the respondents.

 

Sample Selection: Purposive to represent different age groups and a mix of tenants who had moved within same area and others who had been relocated to a new area

 

Sample Size: 22/60 contacted

 

Description of intervention: Rehousing into new-build social rented homes

 

Time since intervention: 3.5-5 years
 

 

Data collection method:

Semi-structured interviews

 

Details of analysis:

Thematic analysis- examination of themes, sub-themes, and relationships between and within themes

 

Year of interviews: 2007-2008

 

 
Residents reported high levels of housing satisfaction, and benefits of improved warmth as well as reduced problems of noise.  Some residents linked these improvements to improved mental health and wellbeing.  Housing type had changed with many (13/22) participants moving from a flat to a house with a private garden; this was associated with increased privacy and reduced exposure to anti-social behaviour.  There were some reports of improved physical health for those who had moved to a dwelling more appropriate to their mobility needs, sometimes this involved downsizing from a house to a flat.  No clear reports of changes in health behaviour were linked to rehousing.  Reports of changes in sense of community and neighbourliness varied, this appeared to depend on an individual’s interest in socialising with neighbours.

Rogers, 2008,

UK

 

Supplementary to quantitative data (Thomas, 2005, included in synthesis)

 
Aim of qualitative data: To obtain further details about subjective views of the locality, effects of urban regeneration programme, psychosocial well-being and perceptions of mental health.

 

Sample Selection: Purposive sample to identify those with significant changes in mental health

 

Sample Size: 20 in depth interviews, and 200 brief interviews

 

Description of intervention: Urban regeneration programme

 

Time since intervention: Unclear
 

 

Data collection method:

In-depth interviews

 

Details of analysis:

Thematic analysis

 

Year of interviews: Unclear

 

 
Range of factors reported to influence mental health, these included factors of service provision, employment opportunities and exposure to anti-social behaviour.  This was interpreted as implying that the local area and therefore changes in the local area may have an impact on mental health by being a key location for opportunities and threats which affect vulnerability to poor mental health. Ambivalence regarding the experienced and perceived benefits of housing improvement, provision of employment and leisure opportunities. Favourable perception of improved transport. Concern about lack of social control in locality ("nuisance families", vandalism, gangs, threatening behaviour), lack of faith in agencies to make changes considered important to residents, restricted opportunities and entrapment.

Studies excluded from synthesis due to poor quality of data (see table regarding qualitative data prompts)

Intervention Category:  Warmth and energy efficiency improvements (after 1980)

Decent Homes, 2012,

UK

 

Qualitative data only
Aim of qualitative data: Not stated but appears to be to gather residents views of changesData collection method: In-depth interviews

 

Details of analysis: Not reported

 

Year of interviews: ?2010
Residents reported improvements in warmth, safety of heat source (i.e. not open gas fires), and reduced draughts.  There were also reports of improved health.  Previous poor health related to housing conditions was reported by residents to be made worse by housing conditions rather than directly caused by housing conditions.

Allen, 2005,

UK

 

Supplementary to quantitative data (Allen 2005a, included in synthesis)

 
Aim of qualitative data: Not reported

 

Sample Selection: Not reported

 

Sample Size: 16

 

Description of intervention: Warmth- Various- central heating installation/repair, plus general repairs plus health, housing and benefits advice

 

Time since intervention: estimate 1 year
 

 

Data collection method:

Semi-structured interviews

 

Details of analysis:

Not reported

 

Year of interviews: 2003-2004

 
No clear reports of health improvement linked to housing improvement.  However, clear benefits more generally of housing improvements were reported with added value of benefits advice and general project support.  Author concludes that 'how' the intervention was implemented seems to be as important as the intervention itself and that this may explain why there is no relationship emerging between the intervention and a detectable health impact.

Intervention Category:  Rehousing/refurbishment +/- neighbourhood regeneration +/- relocation

Kearns et al, 2006,

UK

 

Supplementary to quantitative data (Kearns 2008, included in synthesis)

 
Aim of qualitative data: Not reported. Open ended questions on recent changes, view of new house, relationships with neighbours, health and wellbeing, strength of attachment to area and wish list of changes to new house.

 

Sample Selection: Not reported- moved to new house 1-3 years previous

 

Sample Size: 28

 

Description of intervention: Rehousing

 

Time since intervention: 12-34 months
 

 

Data collection method:

In-depth interviews

 

Details of analysis:

Not reported

 

Year of interviews: 2004-2005

 

 
Having more space was welcomed and linked to improved family living relations and decreased stress.  Growing sense of community and attachment to the neighbourhood reported, evidenced by reports of looking out for neighbours and keeping the area well maintained.  The process of moving was reported to be unproblematic for most people.  But some building delays were associated with distress and expense.  Following some difficult periods of settling into a new area, most people were pleased with their new house despite leaving an area where they had strong ties.  Residents reported increased pride in their homes and feelings of safety, also that the new houses provided a calming and relaxing home atmosphere.  There was little evidence of change in lifestyles.

 
Table 4. Intervention & Population details: Warmth and energy efficiency improvements (after 1980)

Author, Year, CountryInterventionStudy population

Warmth and energy efficiency improvements (after 1980)

Allen 2005a UKCentral heating installation/repair, plus general repairs (including roofing/guttering), improved bath/shower access, plus health, housing and benefits advice.Owner occupiers (94%) with diagnosed serious heart condition.   60% <65 years, 80% lived in home >10 years,  62% Asian, 60% dependant on benefits.

Allen 2005 UKHeating installation/repair (n=20), reroofing (n=2), replacement windows (n=31), ventilation for those with asthma (n=28), intruder alarm (n=3), general home repair plus health and benefits advice.Residents vulnerable to poor housing referred for health reasons to project (referral criteria- coronary heart disease, cerebro-vascular accident, peripheral vascular disease, type II diabetes with functional difficulties, chronic obstructive pulmonary disease, asthma children with complex and life limiting diseases).  All income derived from welfare 46%,  83% of Pakistani origin.

Barton 2007 UKUpgrading heating provision and energy efficiency according to need.  Included installation of full gas fired central heating, upgrading of partial heating and/or renewal of undersized boilers. Installation of extract fans controlled by ambient temperature and humidity.  For some houses, roofs were fitted with breathable roofing felt, plus 50mm insulation, Cavity insulation with rockwool fibres, and double glazing. Over ceiling insulation topped up to 200mm (glass fibre quilting), Front and back doors and French windows were replaced with uPVC doors.Social housing tenants in deprived area (Jarman index  of socio-economic deprivation 22.7- regional level of 12.8 (Devon)). 58% <20 years, 10% <50 years.

Braubach 2008 GermanyThermal insulation and where required central heating and energy efficient window replacement.Residents of social housing in three neighbourhoods of Frankfurt.  Mean age 46 years (range 1-97; 1-17 years 13%, 18-64 years 60%, >64 years 27%); Male/Female 42%/58%. Mix of low and middle income households.

CHARISMA 2011

UK
Provision of ventilation (VentAxia HR200XL) and where required improved or replaced central heating tailored to household.  Ventilation device delivers filtered fresh air to first floor bedrooms, and removes stale air, replacing moist air with fresh air.  System as 70% heat recovery and costs around £15 annually to run.Children aged 5-14 years prescribed >2 steroid inhalers in past year

Health Action Kirklees UKInstallation of heat recovery unit and insulation measures (cavity wall insulation, loft insulation (full or top up),  hot water tank jacket and draught proofing)Private householders, under 60 years/with young children/not in receipt of welfare, who suffer from or are at risk from cold related illness (confirmed by health professional).

Hopton 1996 UKImproved heating. Heat-with-rent controlled heating central heating system for every room in house, and responds to external temperature.  Tenants pay a fixed sum which is incorporated into their rent.Social housing tenants in isolated deprived neighbourhood: 42% household with someone unemployed.

Howden-Chapman 2007 New ZealandCeiling insulation, draught-proofing of windows and doors, sisalated paper (insulated foil) strapped under floor joists, and polyethylene covering over the ground.Various tenures (24% rented, 76% owner occupier- nationally 32%/68%).  At least one person in household suffered from respiratory disease, lived in uninsulated house.  66% in bottom 3 deciles of deprived areas. Ethnicity: 49% Maori migrant pacific.   66% in bottom 3 deciles of deprived areas.

Howden-Chapman 2008 New ZealandReplacing 2kW electric heaters or portable unflued gas heaters with ≥4kW non-polluting alternative.

Choice of 3 heaters: 131 (73.6%) heat pump, 39 (21.9%) wood pellet burner or 5 (2.8%) flued gas heater. (No indication of proportion of each intervention by Int & Cont group).  All homes were (where necessary) brought up to the NZ building code standard before baseline data collection.
Four New Zealand cities. Households with child (6-12 years) with Dr diagnosed asthma in house with main form of heating plug in heater or unflued LPG heater. Mean age 9.6 years, ˜58.5% male, ˜36.5% Maori (compared to 15% general population), 47% NZ European Int/Cont.

Iversen 1986 DenmarkReplacement windowsPrivate low-rise flatted housing in middle income area

Lloyd 2008 UKInsulation (double skinning of walls) and draught proofing, gas central heating, double glazing, solar panels, dual-purpose heat recovery system, and front and back verandahs within internal living area of the flat.Social housing tenants in deprived neighbourhood

Osman 2010 UKReplacement/upgrade of central heating, installation of loft, under-floor and cavity wall insulation, and welfare benefit reassessment.Elderly people with recent hospital admission for COPD living in own homes (47% social housing)

Platt 2007 UKInstallation/repair/upgrading of central heating (choice of gas/electric/oil/solid fuel) plus insulation (where possible cavity wall fill, lagging of boiler pipes, loft insulation, draft exclusion measures), safety alarms where appropriate (carbon monoxide detector, smoke alarm, cold alarm), advice on energy use, and benefit entitlement check offered.Social housing tenants (53.5%) and owner-occupiers (41.5%).  Mean age 62 years, Male/Female 36%/64%, socio-economically deprived 61%, predominantly pensioners with no children in house.

Shortt 2007 Northern IrelandEnergy efficiency measures: included central heating, insulation and/or provision of new electrical appliances.  Also promotion of benefit uptake for whole area (Int & Cont)High percentage >60 years and <5 years. High proportion owner occupiers/private rented housing in rural areas, in receipt of welfare benefits. 78% Int group houses built pre-1950. Low uptake of domestic energy efficiency improvements;  Areas in middle range of deprivation index.

Somerville 2000 UKGrant up to £2,500 to improve heating and reduce damp and mould growth in house, intervention agreed according to need. (Gas central heating, n=28 (47%), electric storage heater, n=22 (37%), solid fuel central heating, n=7 (12%), oil-fired central heating, n=2 (4%)).Asthmatic children under 16 years living in social housing reported to have damp.

 
Table 5. Intervention & Population details: Rehousing or retrofitting with or without neighbourhood renewal (after 1995)

Author, Year, CountryInterventionStudy population

Rehousing or retrofitting with or without neighbourhood renewal (after 1995)

Ambrose 2000 UKRehoused to better accommodation, or had existing accommodation improved plus neighbourhood improvements (Single Regeneration Budget) plus other employment and education initiatives related to regeneration programme.Social housing tenants. High levels of socio-economic deprivation ( in receipt of income support 65.4%; unemployed 9.2%).  Bangladeshi 69.2%, White 18.7%.

Barnes 2003 UKRefurbishment or rehousing (some included warmth improvements).Social housing tenants.  Mixed age groups, 32% have some form of disability.  Ethnicity: 65% White; 23% Black/Asian.

Blackman 2001 UKRefurbishment or demolition of void dwellings, discretionary renovation grants for individual dwellings, heating and security improvements. Landscaping, environmental improvements- security and road safety measures (traffic calming), footpath improvement.Residents of neighbourhood renewal area, mixed tenure (56.1% owner occupier; 29.6% social rented), 41.8% in receipt of housing benefit/household with no wage earner;  73.5% 5 years or more lived at this address.  96.4% White; Male/Female 32%/68%; age 0-15 yrs 20.6%; age 16 to 64 yrs 67.5%; age 65+ yrs 12%; Household type (%) n=98 households; Adults plus children 36.1%; Non-pensioner adult(s) only 35.1%; 1+ pensioner household 28.9%.

Breysse 2011 USAComprehensive programme of "green" interventions in a 3 building 60 unit apartment complex, the  programme covered: integrated design process; location & neighbourhood fabric; site; water; conservation; energy conservation; materials & resources; healthy living environment; and operations management.  Housing intervention included the following (as well as other components not described): installation of air handling units to duct fresh air to bedroom & living room (to comply with ASHRAE Standard 62.2); mitigation of radon levels where necessary; use of low VOC products; no smoking in common areas; removal of carpets in wet rooms; installation of fans in kitchen & bathroom; installation of geothermal heating & cooling system; installation of high performance (U-value 0.32) windows; insulation to exterior walls (adding R-value 7.5 to existing R-value 11) and to roof; replacement water fixtures in kitchen & bathroom; installation of dual flush toilets & low water clothes washers.Low income (annual household income $28,000), minority ethnic groups (Adults: White-Hispanic 9%; White-nonHispanic 36%; African 32%, African-American 9%), 67% Female.  57% adults born outside USA.

Critchley 2004 UKLow-income tenants moved from poor-quality (hard to heat with damp, mould & condensation problems reported to be highly prevalent) tower blocks to high-quality low-rise new build accommodation.Social housing tenants. Predominantly retired and dependent on welfare: 66% > 60 years.

Evans 2000 UKRenovation of housing, include installation of central heating and double glazing according to need.Private householders in socio-economically deprived urban area.

Halpern 1995 UKHousing refurbishment and neighbourhood regeneration.  Some housing improvement and with major re-design of estate- to reduce traffic speed, improve visibility of parked cars.Social housing tenants. High number female single parent families; Mean age females interviewed at stage 1, 2 ,3 = 42.4, 39.8, 40.2 yrs respectively.  Mean years at present house 8.2;  mean number of children <14 years 1.4; 37% employed; mean reported household income £97-134/wk.

Kearns 2008 UKRehousing into new build socially rented homes (considered to be upgraded conditions to previous homes) in 60 sites in Scotland (47% also relocated to different neighbourhood)Social housing tenants. Age <30 yrs 15.8%; >60 yrs 14.4%; 77.9% urban resident, 21.4% rural resident.

Molnar 2010Moved to refurbished or new house (previously living in life threatening conditions).Roma adults living in disadvantaged rural village. Previously living in life-threatening conditions.

Thomas 2005 UKHousing-led neighbourhood regeneration (Single Regeneration Budget) plus other employment and education initiatives related to SRB. Housing improvement mostly improvements to heating, bathrooms, kitchens and windows.  Also transfer from housing ownership from local authority to housing trust.Social housing tenants in deprived area. Mean age Int/Cont 51/53, Male/Female 52%/48%.

Thomson 2007 UKHousing-led neighbourhood regeneration.  Replacing ex-local authority owned social housing stock reported to have problems with damp and mould with new-build housing in the same locality.  Accompanied by improvements in physical and social neighbourhood environment.Social housing tenants.  More than half of participants were dependent on housing benefit.

Wells 2000 USARehousing (renovation of existing homes n=3) to improved housing with sufficient room.  Participation required ability to pay mortgage and contribute labour hours to house-building/renovation (around 400 hours per family).Families on fringe of home-ownership, in need of improved housing and willing to enter commitment of housing partnership including mortgage contributions.  74% female head of household; family size 2 to 8 persons.  Mean income/month $1,396, mean income to needs ratio=1.10 (1.0=poverty line).  Ethnicity: 61% African-American, 37% White; mean age 33 years.

 
Table 6. Intervention & Population details: Provision of basic housing needs/low or middle income country intervention

Author, Year, CountryInterventionStudy population

Provision of basic housing needs/low or middle income country intervention

Aziz 1990 Bangladesh148 water hand-pumps (adding to existing 6 hand-pumps), household double pit water-sealed latrine, plus Hygiene education messages to promote water use and safe water sanitation practices delivered over two years.Children living in agricultural villages in rural Bangladesh.  Household data: % Illiterate adults male/female 49/78, 77% Muslim.

Rojas de Arias 1999Two interventions: A- Modifying housing structure to ensure smooth, flat, and crack-free walls and ceiling surfaces and improving opening for ventilation and light. B-  Insecticide spraying of house with Labdacyhalothrin.  One group received intervention A, one intervention B, and one intervention A & B.Rural households  50-100km from capital of Paraguay. Housing mainly made of mud walls and thatched roof.

Spiegel 2003 CubaRepair of external housing e.g. leaking roofs, façade repair. Cheap materials provided for residents who want to carry out internal repairs themselves.

Wider neighbourhood improvements- repair of public buildings, streets, improvement of water supply & solid waste removal, installation of street lighting.

Social- new leisure/cultural venues and new social cultural activities (exercise groups, self-esteem groups for elderly, music clubs for youth etc)
Urban neighbourhood with predominantly dilapidated buildings and inadequate basic amenities such as potable water.  Male/Female 41%/59%, mean age 45.1 years, education 11.2 years (mean), Ethnicity: White 58%, Mulatto/Black 36%.

 
Table 7. Intervention & Population details: Rehousing from slums (before 1970)

Author, Year, CountryInterventionStudy population

Rehousing from slums (before 1970)

Chapin 1938 USARehousing and relocation from slum housing/neighbourhood to housing/neighbourhoods with slightly better living conditionsResidents of housing with inadequate facilities in neighbourhood with high crime rate. Many households foreign born with large families. Ethnicity: Black 62% Jewish 23% White 15%

McGonigle 1936 UKMoved from slum housing estate (demolished) to new build houses on self-contained municipal housing estate.Residents of slum areas with higher mortality rates than rest of England and local borough; 18.75 & 22.15 deaths per 1,000 compared with 12.00 & 13.96.

Wilner 1960 USARehousing (moving into new public housing) with better facilities regarding water, heat, kitchen and toilet.Black families living in slum areas.

 
Table 8. Combined Risk of Bias & Hamilton Critical Appraisal (ordered by intervention category, study quality (Hamilton) and year of publication)

  Cochrane Risk of BiasHamilton Tool 





Author, publication year, countryStudy Design, Sample Size (Int/Cont)Random sequence generation

(selection bias)
Allocation concealment (selection bias)Blinding of participants and personnel (performance bias)Blinding of outcome assessment (detection bias)Blinding of analystsIncomplete outcome data (attrition bias)Selective reporting (reporting bias)Baseline outcome characteristics similarBaseline characteristics similarContaminationBaseline responseImplementation of interventionSelection biasConfoundingWithdrawalsData collectionBlindingOverall GradePerformance bias

Intervention : Warmth and energy efficiency improvements (post 1980)

CHARISMA, 2011, UK19/19*LL??L?LL??HHCAAABAC

Osman et al, 2010, UKRCT

45/133
??????LLLH??CAABCAC

Howden-Chapman et al, 2008, New ZealandRCT

175/174
?L???L?LL???CAAACAC

Braubach et al, 2008, GermanyCBA

˜210/165
HH?????L??H?CBBACAC

Barton et al, 2007, UKRCT

14/13
LL????HLL?LHAAAACAC

Howden-Chapman et al, 2007, New ZealandRCT

1689/1623
?L???L?LL??HCABACAC

Platt et al, 2007, UKCBA

1281/1084
HH?????L?H?LCBBACAB

Lloyd et al, 2008, UKCBA

9/27
HH?????L??L?BCCBCBC

Shortt et al, 2004, Northern IrelandCBA

46/54
HH?????HH??HCCBACBC

Somerville et al, 2000, UKUBA

72
HHHHH??HHHL?BCBACBB

Hopton & Hunt, 1996, UKCBA

55/77
HH????????L?ACCBCBC

Allen, 2005, UKUBA

16
HHHHH??HHHHHCCCACCC

Allen, 2005, UKUBA

24
HHHHH??HHH?HCCCACCC

Health Action Calderdale Kirklees and Wakefield, 2005, UKRU

102
HHHHHH?HHHL?BCCACCB

Iversen et al, 1986, DenmarkCBA

106/535
HH?????LL??LCCCBCCB

Intervention : Rehousing or retrofitting with or without neighbourhood renewal (post 1995)

Kearns et al, 2008, UKCBA

262/284
HH?????LH???CCBACAC

Thomson et al, 2006, UKCBA

50/50
HH?????LL?HLCBBACAB

Critchley et al, 2004, UKCBA

246
HH????????HLCBBACAB

Thomas et al, 2005, UKCBA

585/759
HH?????L?HHHCBCACBC

Barnes, 2003, UKCBA

45/45
HH?????HH?LHACCACBC

Evans et al, 2002, UKCBA

17/17
HH?????????HCBCACBC

Breysse et al, 2011, USARU

41
HHHHH??HHH??CCCACCC

Molnar,  2010, HungaryUBA

19/42
HHHHH??HHH?HCCBCCCC

Blackman and Harvey, 2001, UKUBA

166
HHHHH??HHHL?BCCACCC

Wells, 2000, USAUBA

31
HHHHH??HHHHLCCBACCB

Ambrose, 1999, UKUBA

227
HHHHH??HHHLHACCACCC

Halpern, 1995, UKXUBA

27
HHHHH??HHH?HCCCACCC

Intervention : Provision of basic housing needs/low or middle income country intervention

Rojas de Arias 1999 ParaguayCBA (3 interventions) 229/260/132HH?????HH???CCAACBB

Spiegel et al, 2003, CubaXCBA

896/807
HH???H?????HCCCACCC

Aziz et al, 1990, BangladeshXCBA

>200/200
HH?????LL???CBCBCCB

Intervention : Rehousing from slums (before 1965)

Wilner et al, 1960, USACBA

1891/2893
HH?????????LBBAACAB

Chapin, 1938, USAUBA

23
HHHHH??HHHHLCCABCCB

McGonigle & Kirby, 1936, UKXCBA

152/289
HH??????????CBCBCCC

Study designs: RCT = randomised controlled trial; CBA = controlled before and after; XCBA = cross sectional controlled before and after; UBA = uncontrolled before and after; RU = retrospective uncontrolled. Risk of bias: H = high, L = low, ? = unclear.

*only this sub-group of whole sample (n=89/89) who received warmth improvements, with controls matched for timing of intervention

 
Table 9. Summary of included study characteristics and findings (ordered by study quality (Hamilton Overall Grade), date of publication and study design) portrait

Author, publication year, countryStudy design, final sample size, number and times of  follow-upSummary


Summary of resultsSelectionConfoundingWithdrawalsData collectionOverall gradeNo. of items  at low Risk of Bias

 
Intervention  integrity









Intervention : Warmth/energy efficiency improvements (post 1988)

CHARISMA, 2011, UK

 
Randomised controlled trial

Final/baseline:

Sub group of 36 (Int/Cont 19/19)  at follow-up

Int/Cont 88/89 12 months since baseline

Twice: 3 & 11 months after intervention
CAAAA5C









 Health:  Time I/II (4 months/12 months since baseline) Sub-group analysis by type of improvement:  Mean difference adjusted for baseline (95% CI)  Ventilation only (Int/Cont n=69/70)/ Ventilation & central heating (Int/Cont n=19/19)  overall asthma scale 6.8 (2.1 to 11.5)*/9.3 (-1.9 to 20.6)/; physical scale 3.7 (-1.8 to 9.1)/10.3 (-1.7to 22.4); overall psychosocial scale 2.7 (-1.8 to 7.2)/0.6 (-10.1 to 11.3).

Whole sample analysis comparing intervention not included in review (mould removal & installation of fan) with control. Mean difference in PedsQL subscales and overall scales (scores out of 100- higher values indicate better health) adjusted for baseline (95% CI) asthma subscales: symptoms 9.0 (3.8 to 14.3)/9.6 (4.0 to 14.9); treatment 4.4 (0.4 to 8.4)/4.7 (10.2 to 9.2); worry 6.6 (-0.3 to 13.4)/ 6.2 (-0.5 to 12.9); communication 2.1 (-6.0 to 10.2)/10.1 (2.2 to 18.0); overall asthma scale 6.3 (2.1 to 10.4)/7.1 (2.8 to 11.4).  Physical scale 7.2 (2.6 to 11.8)/4.5 (-0.2 to 9.1). Psychosocial subscales- emotional 5.8 (0.6 to 11.0)/3.6 (-1.5 to 8.8); social 1.2 (-4.0 to 6.5)/2.5 (-2.5 to 7.6); school 2.3 (-2.7 to 7.4)/ 1.8 (-3.2 to 6.7); overall psychosocial scale 3.0 (-1.3 to 7.2)/ 2.2 (-1.9 to 6.4).

Other (whole sample):  Mean number of parent reported days absent from school Int/Cont- all causes 9.2 (median 7)/13.2 (median 9) p=0.091; asthma related 3.0 (median 0)/6.4 (median 2) p=0.053. Economic analysis reports costs of health service use but no data on health service use reported.


Osman et al,

2010,

UK
Randomised controlled trial

 

Final/Baseline: 96/118 individuals (81.4%)

 

Once: 20 months since baseline, 5 months since intervention
CAABA4C









 Health Φ: ITT analysis n= 59/59 (Int/Cont Before v After) (difference at follow-up between Int & Cont adjusted for baseline score, 95% CI) St Georges Respiratory Questionnaire Total (SGRQ) 68/68 v 69.8/68.9 (-0.9, -6.7 to 4.9); SGRQ Symptom score 73.8/76.5 v 73.2/77.1 (-3.5, -11.3 to 4.3); SGRQ Impact score (56.7/57.1 v 61.0/58.8 (3.0, -4.3 to 10.2)); SGRQ Activities score 85.5/83.0 v 83.5/82.6 (-1.4, -7.7 to 4.8); Visual Analogue Scale 50.3/47.1 v 48.5/48.5 (-0.3, -1.2 to 0.6). Hospital admission for Chronic Obstructive Pulmonary Disease (COPD) in past year 1.1/1.1 v 1.5/1.1 (0.4, -0.4 to 1.1).  TOT conducted- see full study findings in appendix.

 

Housing: ITT analysis (Before v After Int/Cont) (difference at follow up between Int & No Int adjusted for baseline value, 95% CI)  NHER 5.1/5.5 v 5.5/5.7 (0.2, -0.1 to 0.6); estimated Annual Fuel Costs (EAFC) £696/533 v £647/580, (-12.1, -52.4 to 28.7); hours at 21oC in one week (Oct-May) living room 55.9/73.1 v 59.4/64.0 (7.4, -11.0 to 25.8); bedroom hours at 18oC 100.2/109.5 v 111.9/102.2 (22.4, 1.6 to 43.4)*; Living room Average humidity g-kg-1 46.4/60.0 v 43.8/43.0 (-1.7, -4.9 to 1.6); Bedroom Average humidity g-kg-1 50.0/65.4 v 49.5/48.7 (-0.8, -3.5 to 1.9).


Howden-Chapman et al,

2008,

New Zealand
Randomised controlled trial

 

Final/Baseline sample: 349/409 (85.3%) children

 

Once: 4-5 months since intervention. 12 months since baseline
CAAAA5C









 Health Φ: (OR for Int group adjusted for baseline measure where available) (95% CI) Parent reported measures- poor/fair health (as opposed to good/very good/excellent) (n=346, ˜50% Int group) OR 0.48 (0.31 to 0.74)***; sleep disturbed by wheeze (n=344) OR 0.55 (0.35 to 0.85)**; wheeze limits speech (n=344) OR 0.69, (0.40 to 1.18); wheeze during exercise (n=344) OR 0.67 (0.42 to 1.06); dry cough at night (n=345) OR 0.52 (0.32 to 0.83)*; diarrhoea (n=343) OR 0.72 (0.45 to 1.16).  Asthma symptom data from diary (Int/Cont n=178/182) (adjusted for baseline value) Mean Ratio (MR: mean score Int divided by Cont) (95% CI) cough at night (n=333) MR 0.72 (0.59 to 0.89)**; cough on waking MR 0.67 (0.53 to 0.84) ***; cough during the day MR 0.84 (0.70 to 1.01).  Mean for Int compared with Cont (adjusted for baseline value) (95% CI); asthma visits to GP (n=323) -0.40 (-0.62 to +0.11) *; other visits to GP (n=333) -0.27 (-0.46 to -0.01)*.

 

Housing:  At TI Mean temperature over 4 winter months (oC)- living room Int v Cont 17.07 v 15.97, p<0.001 (95% CI 0.54 to 1.67); child’s bedroom 14.84 v 14.26, p=0.03 (95% CI 0.05 to 1.08); degree hours per day <10oC (hours per day multiplied by number of degrees below 10oC) 1.13 v 2.31, p=0.001 (95% CI 0.49 to 1.93); hours per day <10oC in child’s bedroom 2.03 v 4.29, p<0.001 (95% CI 0.99 to 2.34).  Mean NO2 over one month- in child’s bedroom (μg/m3) (Int v Cont) 7.3 v 10.9, p<0.001; living room NO2 8.5 v 15.7, p<0.001 (outdoor NO2 levels unchanged).

 

Other Φ: Mean school absence (days of absence reported by school) Int/Cont 7.6/9.6, effect ratio 0.79 (95% CI 0.66 to 0.96).  Sub-group analysis reported greater effect ratio for those whose pre-intervention heat source was an unflued gas heater (compared to an electric heat source) effect ratio 0.72 (95% CI 0.55 to 0.93).


Braubach et al,

2008,

Germany
Controlled before & after

 

Final/Baseline: 375/600 (62.5%)

 

Once: 11-13 months since baseline; 5-8 months since intervention
CBBAA2C









 Health:  (n=375, proportion of Int/Cont unclear Int ˜56%) Self-reported health improved (Int/Cont) 29% v 13%; Depression- strong trend (actual measure unclear but includes self-reported sleep disturbance, loss of appetite, lack of motivation, lack of self-esteem) Before v After (Int/Cont n=179 v 157/130 v 131) 1% v 3.2%/0.8% v 2.4%, OR 1.404 (95% CI 0.329 to 5.987).  Respiratory outcomes: Before v After Int/Cont, acute bronchitis in past 3 months 7% v 6.5%/5% v 7%; common cold 35% v 33%/33% v 38%; chronic bronchitis/emphysema 10% v 9.5%/5% v 8%; asthma 10% v 10%/5% v 6%. 

 

Housing Φ (n not consistently reported):  Living conditions unchanged at follow-up (Int/Cont) 32.8%/93.3%; housing satisfaction (want to stay in flat forever) Before v After (Int/Cont) 3.0% v 3.1%/3.9% v 3.7%; house less cold since renovation (Int/Cont) 68.7%/34.6%.  Problems reduced since renovation (householder reported) (Int/Cont n=234): draughts 21%/2%; dampness/condensation 18%/4%; mould 12%/4%; frequent noise disturbance Before v After (Int/Cont) 23% v 16%/23% v 27%.  Physical housing measures also reported.


Barton et al,

2007,

UK
Randomised controlled trial

 

Final/Baseline sample: 426/481 (92%)

 

Twice: Total Follow-up maximum of 2 years since intervention
AAAAA6C









 Health Φ: (Time I Int/Cont n=193/254) Int/Cont (TI) change in prevalence of asthma -7%/-3%, ns, OR (95% CI) ˜0.95 (0.60 to 1.50);  bronchitis+4%/0%, ns, OR ˜1.00 (0.48 to 2.13); 'other respiratory' (includes bronchitis but not asthma) -1%/+4%, ns, OR ˜1.00 (0.55 to 1.80); arthritis 0%/-2%, ns, OR ˜1.31 (0.73 to 2.34); rheumatism +3%/+2%, ns, OR ˜0.52 (0.16 to 1.67).  Paired analysis (Int/Cont n=14/13 adults, n=25/27 children) No significant difference in changes (Before-After(TI) Int/Cont) for six individual respiratory symptoms; summed score of six respiratory measures: adults -2.3 v +1.1, p=0.006, children -1.8/-1.0, p=0.17. Data on second follow-up when Int & Cont had received intervention not extracted.

 

Housing Φ: Change (Before-AfterTI) mean temperature (oC) (bedroom) (Int/Cont n=49/69) Int v Cont  +2 v +1, (living room) 0 v 0.  No significant changes in environmental measures of air quality- particles (coarse and fine) or airborne microbes or relative indoor humidity.


Howden-Chapman et al,

2007,

New Zealand
Randomised controlled trial

 

Final/Baseline sample: 3312/4407 (75.2%)

 

Once: <12 months since baseline
CABAA4C









 Health Φ: (Int/Cont n=1689/1623 individuals): Change Before v After in Int compared to Cont: 3 SF-36 domains (adjusted for baseline outcome value, household & region) % (95% CI): social functioning +6.2% (3.8 to 8.4)***/role emotional +10.9% (7.1 to 14.6)***/role physical +11.8% (8 to 15.5)***; likelihood of reporting fair or poor health; (adjusted for baseline outcome value, region & household) OR=0.50 (0.38 to 0.68)***; self-report symptoms colds or flu (adjusted for household) OR 0.54 (0.43 to 0.66) ***; wheezing in last 3 months (adjusted for baseline outcome value & household) OR 0.57 (0.47 to 0.70) ***; sleep disturbed by wheezing (child 0-12 years) (adjusted for household) OR 0.57 (0.40 to 0.81)**; hospital admission for respiratory condition (adjusted for region) OR 0.53 (0.22 to 1.29).

 

Housing Φ: Before v After (Int/Cont n=563/565 households) Int compared to Cont at Time I OR (95% CI): house cold most/all time OR 0.62 (0.04 to 0.09)***; mould OR 0.24 (0.18 to 0.32)***; condensation OR 0.16***; energy use OR 0.81(0.72 to 0.91,p=0.0006).  Sub-group (n=140): change in temperature (oC) Int/Cont +0.6/+0.2, p=0.05; % change in relative humidity +3.8/-1.4, p=0.05; difference in average hours per day indoor temperature falls below 10oC -0.99/+0.45, p=0.007. 

 

Other Φ: Days off work (adjusted for region, non-working & working adults in house) Incident Rate Ratio 0.618 (0.466 to 0.818), p=0.001.

 

Economic analysis Φ: Current value of benefits per household (NZ $) at 7% discount rate, reductions in: hospital admissions $1801; days off school $196; days off work $145; energy costs $635.

 

N.B:  All results control for age group, sex, ethnicity- plus other variables where stated.  Unclear about missing data in analysis- 80% data for hospital data, 82% for GP data.  Little change in weather between assessment years.


Platt et al,

2007,

UK
Controlled before & after

 

Final/Baseline sample: 2365/3849 (61%)

 

Twice: 1 year and 2 years since baseline
CBBAA2B









 Health Φ: Before v After (Int/Cont n=1281/1084): (adjusted for attrition, and adjusted for Int/Cont, baseline value, gender, tenure, household composition, serious life event in past year, change in tobacco smoke exposure since baseline, socio-economic group) Since baseline; first diagnosis of heart disease (2 years) OR 0.69, p=0.01; first diagnosis of hypertension OR 0.77, p=0.02; first diagnosis of nasal allergy OR 1.52, p=0.03.  No significant change in Int compared to Cont for: other cardiac & respiratory symptoms, health service use, medication, longstanding illness, smoking, alcohol consumption.  Small increase (improvement) in 2/6 SF-36 domains (general health & physical functioning- but unlikely to be clinically significant.

 

Housing Φ: Int compared to Cont group: home warm enough in winter (n=2289) OR 3.5**; more than half of rooms permanently unheated in cold weather (n=2149) OR 0.22 (0.16 to 0.29)**; average hours of heating (n=2149) 1.12 (0.6 to 1.64)**; any rooms in home not used due to damp/condensation (n=300) OR 0.39*; ‘would not want to move home if able to do so' (n=2207) OR 0.83 (0.69 to 0.99)*.

 

Other Φ: friends/relatives dissuaded from visiting due to poor housing conditions (n=2322) OR 0.4 (0.23 to 0.70)**; financial difficulty (n=2318) (not adjusted for tobacco smoke exposure) OR 0.77 (0.6 to 0.99)*. 

 

See full data extraction for details of independent variables in analysis.


Lloyd et al,

2008,

UK
Controlled before & after

 

Final/Baseline sample: 36/68 (52.9%)

 

Once: at least 1-2.5 years since intervention; 4 years since baseline
BCCBB2C









 Health:  (Int/Cont n=27/9) Mean change in blood pressure (mmHg) (Int/Cont- paired means, 2 sample t test): systolic -19.36/+2.78, difference in change 22.14 (95% CI 13.77 to 31.12)*** ; diastolic -11.85/+8.22, difference in change 20.07 (95% CI 12.70 to 27.44)***.  At least 4 years after time of intervention (Int/Cont n-75/40), Intervention group report improvements in respiratory health and some other improvements in health and illness, and reduced need for medical attention. (unclear how these data were obtained)

 

Housing:  At least 4 years after intervention (Int/Cont n=75/40), Intervention group report heating costs reduced from £35 per week to £7 per week, no change in rent.  Control group do not report any changes in housing costs. (unclear how these data were obtained).


Shortt et al,

2004,

Northern Ireland
Controlled before & after

 

Final sample: 245/378 (65%) households.  Data presented for 46/54 households Int/Cont (144 households received partial intervention- data not presented).

 

Once: 1-3.5 years since intervention
CCBAB0C









 Health Φ:  (Int/Cont n=46/54 households) Prevalence of specific illnesses (%) Before v After (Int/Cont), ˜OR (Compares Int v Cont): angina 17.4 v 4.3, ns/ 0.0v 1.8, ns, OR ˜0.2*; arthritis/rheumatism 34.8 v 8.7*/10.9 v 5.5, ns,OR ˜1.62; asthma 15.1 v 4.3, ns/10.9 v 6.5, ns, OR ˜0.57; chest infections/bronchitis 26.0 v 13.0, ns/1.8 v 7.3, ns, OR ˜1.88; pneumonia/hypothermia 2.1 v 2.1, ns/0.0 v 0.0, ns, ˜OR 3.60; stress/mental illness 10.8 v 4.3, ns/1.8 v 14.5*, OR ˜0.26; other illnesses 28.2 v 4.3*/3.6 v 7.2, ns, OR ˜0.57; mean number of illnesses per head 1.43 v 0.91*/0.17 v 0.23, ns. 

 

Housing Φ: Mean satisfaction with house temperature during cold periods Before v After (Int/Cont) (10 pt score) 3.57 v 9.18***/8.19 v 8.35, ns; mean number of rooms with householder-reported condensation/mould/damp Before v After (Int/Cont) 2.1 v 0.7***/1.5 v 1.1, ns.

 

Economic: mean number of welfare benefits awarded Before v After (Int/Cont) 1.78 v 1.87, ns/0.02 v 0.71***.


Somerville et al,

2000,

UK
Uncontrolled before & after

 

Final/Baseline sample: 72/114 (63%)

 

Once: 3 months since intervention
BCBAB1B









 Health Φ:  (n=72 children, 59 households) Before v After (median) cough by day 2 v 1***; cough by night 3 v 1***; wheeze by night 2 v 0***; breathless with exercise 2 v 1**; breathless 1 v 0***; runny nose 2 v 0***; blocked nose 2 v 0***; hay fever 0 v 0, ns; diarrhoea 0 v 0. 

 

Housing: (n=72 children, 59 households) Children sleeping in unheated /damp/damp & mouldy bedrooms 92% v 14%*/61% v 21%*/43% v 6%* ; children living with furred/feathered pets 63% v 78% ns, living with at least one smoker 71% v 64% ns.

 

Other: Days lost from school due to asthma (rate per 100 school days) Before v After 9.3 v 2.1, mean difference (paired) 7.27 (95% CI 3.32 to 11.21 ***), mean difference for days off school due to other causes -1.8 (95% CI -3.86 to 0.26). 

 

Economic analysis Φ (n=47): Net benefits per year considering cost of improvement (£3061), savings on fuel bills, saving on NHS treatment costs, prescribing costs, increase value of school attendance: £413.32 per household per year.


Hopton & Hunt,

1996,

UK
Controlled before & after

 

Final/Baseline sample: 258/532 (48.5%)

 

Twice: 6-12 months since baseline; 5-11 months since intervention.
ACCBB1C









 Health Φ: (Int/Cont n=55/77 households) Before v After Int/Cont. Children’s symptoms: mean number symptoms 3.69 v 3.72/3.09 v 3.89. Regression analysis (adjusted for smoking, changes in other housing conditions, unemployment, perceived financial situation) change in reported level of dampness was the only significant predictor of change in reporting of runny nose**, intervention not independent predictor or mean number of symptoms.

 

Housing: (Int/Cont n=55/77 households) Before v After Int/Cont House too cold 65.5% v 10.9% ***/55.8% v 46.8%, ns; problem with dampness 74.5% v  32.7%***/58.4% v 57.1%, ns; one or more rooms not heated in past 2 weeks 78.2% v 3.6%***/68.8% v 75.3%, ns; one or more rooms prefer not to use due to dampness 20.0% v 9.1%, ns/26.0% v 35.1, ns; estimated weekly heating cost (£) 4.45 v 1.86/3.33 v 3.49.


Allen,

2005,

UK
Uncontrolled before & after

 

Final sample: 29/49 (59%).

 

Once: <12 months since intervention & baseline
CCCAC0C









 Health: (n=16) Before v After mean GHQ score 6.5 v 2.6 paired t-test p=0.001.

 

Housing: (n=29) After self reported housing conditions ‘a lot better’ 83%; 'a little better' 17%; Before v After sufficient heating to keep everyone warm  35% v 90%; winter temperature in living rooms ‘is about right’ (n=26) 31% v 92%; draughtiness 'in the winter my living rooms are usually about right' (n=26) 17% v 75%.


Allen,

2005,

UK
Uncontrolled before & after

 

Final/Baseline sample: 32/64-71(50%-45%)

 

Once: <3 years since intervention & baseline
CCCAC0C









 Health:  Before v After paired analysis (n=24) Mean SF36 Physical Component Score (PCS) 36.1 v 35.8, ns; Mental Component Score (MCS) 39.7 v 45.9, p=0.013; Mean HADS anxiety 11.9 v 9.8 p=0.028; HADS depression 10.9 v 9.5, p=0.106.

 

Housing: (n=33) Before v After have adequate heating 36% v 73%; temperature in living room ‘about right’ 39% v 72%; damp 73% v 54%; housing conditions ‘a lot/little better’ 86%.


Health Action Calderdale Kirklees and Wakefield,

2005,

UK
Retrospective Uncontrolled

 

Final sample: 102

 

Once: 2-8 months since intervention
BCCAC1B









 Health: 78% reported improvement in medical condition; 56% reported reduced medication use; 30% reported reduced GP visits due to improved medical condition.

 

Housing: 94% reported improvement in dwelling warmth; 56% reported reduced housing costs/bills.


Iversen et al,

1986,

Denmark
Controlled before & after

 

Final/Baseline sample: 641/1013 (63%)

 

Three times: 1-4 months; 2-5 months; 3-6 months since intervention & baseline
CCCBC3B









 Health: (Int/Cont n=106/535) Normalised Odds Ratios (OR) (odds for Int group divided by the Cont group odds, normalised to baseline & adjusted for smoking, age, and colds) by month Dec/Jan/Feb.  Symptoms related to mucosal surfaces- eye irritation 0.33/0.00/0.00 (sic); dry throat 0.44/0.52/0.67; rheumatic symptoms- joint pains 0.79/0.41/0.28; neck/back pain 0.38/0.11/0.18. Symptoms reduced but ns different from baseline (% estimated from graphs) Aug v Feb (Int/Cont): dry throat 7% v 7%/15% v 20%; neck pain 12% v 8%/9% v 24%.

 

Housing: (Int/Cont n=106/535)  Normalised OR (normalised to August) for Int divided by Cont group OR: Dec/Jan/Feb low temp 0.15/0.14/0.17; high temp 1.32/1.22/0.79; cold floor 0.15/0.16/0.18; draughts 0.07/0.08/0.06; noise from outside 0.04/0.02/0.03; noise from building 0.33/0.26/0.35.


Intervention : Rehousing/retrofitting +/- neighbourhood renewal (post 1995)

Kearns et al,

2008,

UK
Controlled before & after

 

Final/Baseline sample: 547/723 (75.7%)

 

Twice: 9-12 & 21-24 months since intervention
CCBAA1C









 Health: (Int/Cont n=262/284) (OR: compared to control group, adjusted for baseline value) good health (self reported) OR (95% CI) 1.30 (0.85 to 2.00) p=0.23; health compared to 1 year ago (Int/Cont n=262/284) OR 1.27 (0.86 to 1.85) p=0.23; long standing illness  (Int/Cont n=262/283) OR 0.68 (0.44 to 1.05), p=0.08; SF-36 physical functioning (Int/Cont n=261/284) mean change +0.39/-0.55, p=0.36.  Wheezing in past year (Int/Cont n=262/284) OR 1.04 (0.69 to 1.56), p=0.85; current smoker (Int/Cont n=262/284) OR 1.47 (0.85 to 2.55), p=0.17; heavy drinker (Int/Cont n=261/283) OR 0.61 (0.30 to 1.24), p=0.18; fruit & veg (5+ portions a day) (Int/Cont n=262/284) OR 1.26 (0.82 to 1.92), p=0.29. Mental health: change in mean SF-36 domain scores, Before v After Int/Cont (n=333 v 261/386 v 283) mental health+1.1 v +2.1, p=0.36;  vitality (Int/Cont n=333 v 261/385 v 282) +0.1 v +0.3, p=0.87; social functioning (Int/Cont n=331 v 259/387 v 281) +0.9 v +1.5, p=missing; role-emotional (Int/Cont n=333 v 260/387 v 283) +1.3 v +1.2, p=0.94.  Child Health: Chronic illness (Int/Cont 221/208): asthma 20.8%/20.2%, p= 0.873; eczema* 16.7%/14.9%, p= 0.602; bronchitis * 0.5%/1.0%, p= 0.527.  Health problems in past month (Int/Cont n=222/209); breathlessness 4.5%/3.8%, p= 0.726; sinus/catarrh 9.9%/11.0%, p= 0.710; persistent cough 18.0%/16.8%, p= 0.728.

 

Housing Φ: (Int/Cont) Change in housing: private sector -26.5%/+9.2%; social sector +26.6%/-9.0%; house +34.8%/+3.2%; flat -34.6%/-3.3%; no access to outside space change -19.6%/-2.7%; damp -32.5%/+0.8%; condensation -34.1%/-0.4%; draughts -31.0%/-3.7%; not enough privacy -17.2%/+2.5%; neighbourhood satisfaction 64.5% v 77.9%/82.0% v 79.6%.  Affordability: often difficult to pay: rent/mortgage 21.52% v 7.22%; utility bills 25.94% v 7.25%.

 

Other Φ:  Mean score from 10 psycho-social measures (include measures of privacy, control, safety, identity) (Int v Cont n=257/278) +7.0 v -0.1 ***.   Mean change in size of social network- close friends/relatives (Int/Cont n=262/284) -1.9/-1.4, p=0.52.  Neighbouring: visit neighbours in own homes (Int/Cont n=262/284) OR 1.40, p=0.09; borrow/exchange favours with neighbours (Int/Cont n=262/284) OR 1.17, p=0.40.


Thomson et al,

2006,

UK
Controlled before & after

 

Final/Baseline sample: 100/143 (69.9%)

 

Once: 12 months since intervention
CBBAA3B









 Health: (Int/Cont n= 50/50) Before v After Int/Cont % reporting excellent-good health: 32.6% v 34.8%/40.0% v 46.0%, change +2.2%/+6.0%, ns, OR of better health in Int 0.78; change in SF36 physical component score Int v Cont -1.41 v +0.35  (Int: paired t=1.010; 95%CI -1.42 to 4.24/Cont paired t=-0.238; 95%CI -3.01 to 2.372) OR of higher PCS score in Int 1.04; change in SF-36 mental component score Int v Cont -2.08 v +0.22 (Int paired t=1.094; 95%CI -1.756 to 5.922/Cont paired t=-0.143; 95% CI -3.41 to 2.96), OR of higher MCS score in Int 1.36.

 

Housing: (Int/Cont n=50/50) Before v After Int/Cont Change in ‘no problem with..’: dampness/condensation +24%/+2%, (95% CI 8.82 to 35.18); draughts or leaky windows +28%/+10%, (95% CI 2.62 to 33.38); keep warm in winter +20%/+6%, (95% CI 0.82 to 27.18); heating system +22%/+4%, (95% CI 4.82 to 31.18); ‘other’ housing problems +10%/+12%, (95% CI -10.27 to 14.27) ns; change in mean number of neighbourhood problems Int -1.02 (paired t=1.639, 95% CI -0.231 to 2.271) Cont +0.14 paired t=-0.279 (95% CI  1.148 to 0.868).


Critchley et al,

2004,

UK
Controlled before & after

 

Final/Baseline sample: 268/407 (66%)

 

Once: ˜1-12 months since intervention; 2-3 years since baseline
CBBAA1B









 Health Φ:  (Int/Cont n=˜109/137) Change in SF-36 general health (data estimated from graph) Int Area I/Int Area 2/Cont Area I/Cont Area 2 (Men n=29/19/40/13, Women n=35/26/57/27), Men -3/-0.5/0/-8; Women +0.5/+4/-1.5/-1; SF-36 mental health Men -2/0/0/-1 Women +0.5/+4.5/-1/-1.5 no changes statistically significant at 95% level.  GP use in past two weeks reduced in each group- greatest reduction in Int; increase in hospital attendance across all groups. Energy efficiency ratings (SAP) changed in both groups.

 

Sub-group analysis by change in SAP: Greatest improvement in remaining seven SF-36 domains reported for residents moving from low to high SAP homes (no data reported).

 

Housing & Neighbourhood Φ: Mean SAP ratings (energy efficiency) Before v After IntA/IntB/Cont 62 v 91/19 v 87***/24 v 36. Affordable adequate heating Before v After Int/Cont 75% v 100%/64% v 85%; fuel costs similar in Int and Cont both before and after intervention.  Change in mean temperature oC (n=33 v 34) (living room) Int v Cont +4.7 v +0.1; ‘very satisfied/satisfied with overall comfort’ Before v After (Int n=128) 48% v 92%.


Thomas et al,

2005,

UK
Controlled before & after

 

Final/Baseline sample: 1,344/2596 (51.8%)

 

Once: 22 months since baseline
CBCAB1C









 Health Φ:  (IntCont n= 585/759) Mean GHQ score After Int/Cont 2.621/2.528; Mean diff in GHQ score between Before & After for Int/Cont 0.093/0.057, p=0.647/0.747.  Sub-group analysis of all householders (i.e. both those in and outside neighbourhood regeneration area) comparing those with and without housing improvement  (With/Without treat as Int/Cont n=585/759).  Mean diff in GHQ score between Before & After for 'one housing improvement' +0.053 paired t=0.121, p=0.904 and for ‘no housing improvement' +0.092 paired t=0.620, p=0.535.

 


Barnes,

2003,

UK
Controlled before & after

 

Final/Baseline sample: 90/212 (42%)

 

Three (six attempted): Analysis conducted on 3 follow-ups to 18 months since intervention.
ACCAB1C









 Health Φ: (Int/Cont n=45/45 30% of baseline sample- only follow-up data reported here) % Change Int v Cont (Time III- 18 months since intervention) (% estimated from graphs). Self reported fair/poor health 22% v 50%**, OR for Int compared to Cont ˜0.273 (95% CI 0.110 to 0.682); health problems affecting daily activities 35% v 26%, ns, OR ˜0.52 (0.62 to 3.73); health worse/somewhat worse compared to 1 year ago: 76% v 83%, ns, OR for Int compared to Cont ˜0.356 (95% CI 0.135 to 0.942); mobility problems 25% v 38%, ns OR ˜0.53 (0.22 to 1.32) ; pain and discomfort 33% v 56%*, OR ˜0.40 (0.17 to 0.94); anxiety and depression 32% v 56%*, OR ˜0.36 (0.15 to 0.86); health service use- visit to GP in past month 47% v 60%, ns.

 

Housing & Neighbourhood Φ: (Int/Cont n=45/45, only follow-up data reported here) % Change (baseline to Time III 18 months since intervention) (% estimated from graphs).  Very/fairly satisfied with housing Int v Cont 82% v 70%, ns; very/fairly satisfied with local area as a place to live 82% v 77%, ns; fear of crime affects health of your family a lot/to some extent 61% v 57%, ns; feel very/quite safe in home 80% v 81%, ns; very/quite safe outside home 79% v 67%, ns.


Evans et al,

2002,

UK
Controlled before & after

 

Final sample: 67

 

Once: 6-18 months since intervention; ˜2 years since baseline
CBCAB0C









 Health: Changes in median of SF-36 domains (100 point scales): physical function (Int/Cont n=17/17) -30/-1; general health (n=19/15) +7/-6.

 

Housing: Change in mean household temperature (Int v Cont, n=22) -0.1oC v +0.14oC, some reduction in those reports of cold homes.


Breysse et al, 2011, USA

 
Retrospective Uncontrolled

Final sample: 24 adults & 17 children

Twice: 1-4 & 12-18 months since intervention
CCCAC0C









 Health:  (T1 1-4; TII 12-18 months after intervention) Recalled health better/same/worse since intervention (TI adults n=29) 10/17/2, p=0.042; (TII adults n=18) 5/9/4, p=0.786; (TI child n=30) 7/19/4, p=0.476; (TII child n=15) 5/8/2, p=0.358. General health excellent/good/poor (TI adults n=21) 7/10/4; (TII adults n=21) 13/5/3, p=0.052; (TI child n=17) 9/6/2; (TII child n=17) 11/6/0, p=0.206.  Percentage recalled self-reported change 12 to 18 months since renovation (adults n=22/children n=13): asthma -4%/0%, p=0.317/na;  injury 0%/+18%, p=na/0.083 ; non-asthma respiratory illness -23%/-15%, p=0.025/p=0.317.

Housing Φ: Percent recalling housing conditions comparing pre-intervention condition with 12-18 months since intervention (n=17):  water dampness -26%, p=0.102; musty smell -25%, p=0.046; dehumidifier use -25%, p=0.046; humidifier use +7%, p=0.157; cockroaches -12%, p=0.414; mice/rats -25%, p=0.046; insecticides -19%, p=0.083; smoke inside home -13%, p=0.157; clean >1 time per week +31%, p=0.025.  Radon Before v After 3.1 v 0.7 pCi/litre. Energy use (electricity & gas: British Thermal Units per Heating Degree Days per square foot per year) Before v After 9.76 v 5.05. Air quality data reported but no change data to confirm improvements.


Molnar, 2010, Hungary

 
Uncontrolled before & after

Final/Baseline sample: 9/12 households (75%)

Once: 5 years since intervention
CCBCC0C

 









 Health: Before v After No of people with functional limitation 2 v 2; cardiovascular disease 3 v 5; hypertension 2 v 4; thrombosis 1 v 1; varicsositas 1 v 1; mentally retarded children 5 v 3; epilepsy 2 v 2; brain tumour 1 v 1; spinal hernia 2 v 2; families with children with scabies/louse/impetigo 3 v 2.


Blackman and Harvey,

2001,

UK
Uncontrolled before & after

 

Final/Baseline sample: 208/209 (99%)

 

Once: 5 years since intervention
BCCAC2C









 Health Φ:  Before v After (n=166 adults) self-reported health ‘not good’ 9.7% v 22.0%**; respiratory condition chronic 31.9% v 44.0%*; mental health problems 52.4% v 41.0%*; no significant changes in health service use; prescribed medication for month or more 36.4% v 47.0%*; smoker 71.6% v 27.9% ***. Children (n=43): self-reported health good 73.8% v 79.1%, ns; respiratory condition- chronic 23.3% v 25.6%, ns; mental health problems 20.9% v 2.3%*; visit to GP in past 2 wks 15.9% v 0.0% **; changes in hospital use or prescribed medication for month or more, ns.

 

Housing Φ: Before v After (n=98 households): Dwelling has no draughts 50.0% v 73.5%*; dwelling has draughts that affect health 11.2% v 6.1%, ns; dwelling has no damp 76.0% v 85.7%, ns; dwelling has draughts that affect health 3.1% v 4.1% ns; unable to keep warm last winter 15.4% v 14.3%, ns; happy with present home 85.7% v 84.7%, ns.


Wells,

2000,

USA
Uncontrolled before & after

 

Final/Baseline sample: 23/31 (74.2%)

 

Twice: 5-12 months & 2-3 years since intervention
CCBAC1B









 Health: (n=23) Before v After (Time I) (n=31) PERI (mental health) 31.00 v 22.26***; Before v After (Time II) (n=23) PERI 31.00 v 22.26**; Baseline PERI predicts 31%**; baseline housing quality predicts 12%**; baseline house crowding predicts 12%**; indoor climate predicts 21%** of variance of PERI at Time I.

 

Housing: (n=31) Before v After (Time I) crowding 1.39 v 2.24***; indoor climate 1.79 v 2.30***; cleanliness 1.41 v 1.79***; structural quality 2.79 v 3.00***; hazards 1.29 v 1.46*; overall housing quality 1.73 v 2.14***.


Ambrose,

1999,

UK
Uncontrolled before & after

 

Final/Baseline sample: 227/525 (43%)

 

Once: ˜4-4.5 years since baseline
ACCAC1C









 Health: (Before v After n=525 v 227) Before v After (in previous 4-6 weeks but unclear) cough/cold 41.9% v 66.7%***; aches/pains 22.6% v 11.5%***; asthmatic/bronchial 17.0% v 5.7%***; dietary/digestive 12.4% v 14.9%, ns; stress/depression 6.1% v 1.2%**.

 

Housing: (Before v After n=525 v 227) self reported damp 68.2% v 34.0%***; heating keeps everyone warm 30.8% v 68.0%***; heating not used due to cost 25% v 2%***; infestation 33.6% v 22.0%**; repairs needed 72.9% v 40.0%***; very/fairly satisfied with house 34.6% v 76.0%***; repairs needed 72.9% v 40.0%***; feel quite safe in home 46.7% v 72.0%***.

 

Socio-economic status & other: (Before v After n=525 v 227) Before v After unemployed > 6 months 7.5% v 7.5%, ns; received income support 65.4% v 76.0%**.


Halpern,

1995,

UK
Cross sectional Uncontrolled before & after

 

Final/Baseline sample: 27/55 (49.1%)

 

Once: 10 months since intervention; 3 years since baseline
CCCAC0C









 Health Φ: No panel data- analysed by stage of intervention: T0: no intervention; TI: intervention started in some areas; TII:  intervention complete (T0/TI/TII n=28/57/27).  Hospital Anxiety & Depression Scale (HADS) proportion of anxiety cases (score 8+) 57.1%/45.6%/22.6%, change T0-TII p=0.008; proportion depression cases (score 8+) 25.0%/21.2%/3.7%, change T0-TII p=0.025.

 

Neighbourhood Φ: Sometimes bothered by noise T0/TI/TII 59%/50%/50%, T0-TII ns;  data from one area residents 'very concerned about safety from traffic' (TI v TII) 65% v 39%*; 'very concerned about attack' (T0/TI/TII) 48%/50%/35%, T0-TII ns; describing estate as 'very safe' or 'safe' 41%/34%/81%, T0-TII **; 'good' or 'very good' place to bring up children 22%/34%/52%, T0-TII *; rate area as very friendly 7%/18%/26%, T0-TII ns.


Intervention : Provision of basic housing needs/low or middle income country intervention

Rojas de Arias, 1999, Paraguay

 
CBA (3 intervention groups)

Final: 621/762 individuals (81.5%)

Once: 3-36 months
CCAAB0B









 Health:  Intervention A- Insecticide, B-Housing improvement.  Before v After % Triatomine serology Int A/B/A+B (n=172 v 132/265 v 229/325 v 260) 28.5 v 17.4 p=0.02/14.0 v 12.7 p=0.67/19.4 v 16.9 =0.39.  Sub-group analysis by gender: Int A/B/A+B Male (n=103 v 72/138 v 112/154 v 127) 23.3 v 7.6 p=0.121/13.0 v 14.3 p=0.776/19.5 v 22.8 p=0.492; Female (n=69 v 60/127 v 117/171 v 137) 36.2 v 21.7 p=0.070/15.0 v 11.1 p=0.374/19.3 v 14.6 p=0.278.  Analysis by 17 age groups presented graphically-  suggests no clear age where most likely to observe change in seropositivity.

Housing: Before v After  % Households with Triatomine infestation  Int A/B/A+B (n=51 v 41/61 v 59/70 v 55) 45.1 v 2.4 p<0.000/32.8 v 3.4 p<0.000/48.6 v 16.4 p<0.000.


Spiegel et al,

2003,

Cuba
Cross sectional Controlled before and after

 

Final sample: 1,703

 

Once: between 1-4 years since intervention, 5 years since baseline
CCCAC0C









 Health Φ: (Int/Cont n=896/807) Before v After Int/Cont self-reported excellent-very good health (%) Male (all ages) 31.3 v 78.6***/24.7 v 15.6, ns, Female: no statistically significant change in health; mixed changes in smoking prevalence across male/female and across age groups. 

 

Housing Φ: (Int/Cont n=328/307) Although substantial improvements reported, with some improvements in control group, after intervention (Int/Cont) 77.8%/76.9% reported unmet need for internal housing repair; 79.7%/87.1% for external housing repair.


Aziz et al,

1990,

Bangladesh
Cross sectional controlled before & after

 

Final/Baseline: Cannot tell

 

Three times: 2- 3 & 9 years since baseline, 1-2, 2-3 & 8-9 years since installation of pit latrines
CBCBC2B









 Health Φ: Before v After (1984 v 1987) Int/Cont (Incidence Density Ratio (IDR), 95% CI) Incidence of all diarrhoea episodes per child per year  3.85/3.75 (1.02, 0.96 to 1.09) v 2.34/3.12 (0.75, 0.70 to 0.80**); Incidence of dysentery 0.62/0.54 (1.16, 1.0 to 1.34) v 0.27/0.36 (0.73, 0.61 to 0.88***).  Diarrhoea incidence by age in months: 0-5 months 2.46/2.27 (1.09, 0.87 to 1.36) v 2.43/2.26 (1.08, 0.87 to 1.32); 6-11 months 4.11/4.63 (0.89, 0.78 to 1.01) v 3.33/4.25 (0.78, 0.68 to 0.90***); 12-23 months 4.79/5.17 (0.93, ns) v 3.13/4.12 (0.76, 0.68 to 0.84***); 24-35 months 4.44/4.15 (1.07, ns) v 2.36/3.34 (0.62 to 0.80***); 36-59 months 3.32/2.73 (1.22, 1.10 to 1.34**) v 1.66/2.46 (0.68, 0.60 to 0.75***).  Episodes of diarrhoea per child (under 60 months) per year by disposal of faeces in latrine/Not in latrine (intervention group only) 1986 v 1987 2.10/2.40** v 2.12/2.61***. (Some data reported at 9 years post intervention, see full data extraction table for details).


Intervention : Rehousing from slums (before 1970)

Wilner et al,

1960,

USA
Controlled before & after

 

Final/Baseline sample:4784/4805 (99.6%).

 

Six times: ˜18 months since baseline
BBAAA2B









 Health Φ: (Int/Cont Time V (18 months after baseline) n=1891/2893) At least 1 day disability in past 2 months OR ˜1.145 (95% CI 0.98 to 1.34). Change (Time I-After (Time V)) illness episodes in past 2 months (rate per 1000) Int v Cont (all ages), Time I-Time V -431.1 v -362.3.  Change (Before-After (Time VI), Int/Cont n=396/633-377/583) Int v Cont nervousness +1.0% v +2.3%***, OR ˜1.16 (0.89 to 1.50); negative mood  -13.6%*** v -10.6%***, OR ˜0.91 (95% CI 0.70 to 1.82); dissatisfaction with status quo -23.3%*** v -19.5%***, OR ˜0.86 (0.66 to 1.12); potency  -4.9% v -11.5%***, OR ˜0.81 (0.63 to 1.05); pessimism -8.8%* v -11.2%***, OR ˜0.82 (0.63 to 1.06); emotionality -3.0% v +4.8%, OR ˜0.80 (0.61 to 1.03). Among Cont group who had moved (n=195, large/moderate/no housing improvement 52/75/68) there was a dose-response relationship demonstrated for morale measures directly linked to degree of housing quality improvement between Baseline and Time VI: optimism scale (large/med/no change in housing quality, ˜OR compares large & no housing improvement) +25.0%/+16.0%/+5.9%, ˜OR 5.33 (this analysis includes 33% of Cont group at Time VI and appears to include only half of the ‘control group movers’ this may be due to movers who were untraceable).

 

Housing Φ:  Change (Before-After, Int/Cont 396/633-377/583) ‘how do you like apartment?’ Int v Cont +55.3%*** v +16.5%***; “deficiencies such as lack of hot water, sharing of facilities, crowding, lack of central heating, and infestation were wiped out”.

 

Other Φ: Change (Before-After, Int/Cont 396/633-377/583): ‘places where children play are not safe’ -39.8%*** v +0.5%, ns;  ‘family often sit and talk’ +11.1%** v +1.9%, ns; feel ‘better off’ compared to 5 years ago +19.0%*** v +4.0%, ns.


Chapin,

1938,

USA
Uncontrolled before & after

 

Final/Baseline sample: 171/198 (86.4%) households.

 

Once: 8-19 months since intervention
CCABC2B









 Health: (n=171 families) Before v After mean morale score  65.5 v 63.52 (improvement).  Sub-group analysis of % change in mean morale score by change in overcrowding (fall indicates improvement): Improvement not clearly related to overcrowding. Before v After overcrowded before & after move (n=18) -2.5%; moved from overcrowded to not-crowded (n=23) -3.8%; moved from not overcrowded to overcrowded (n=24) -8.5%.

 

Housing:  Before v after mean no of rooms 5.22 v 4.78; person to room ratio 0.82 v 0.83; mean dwelling unit rental $15.68 v 17.98.


McGonigle & Kirby,

1936,

UK
Cross-sectional controlled before & after

 

Final/Baseline sample: unclear/441 households

 

Once: 5 years since intervention
CBCBC0C









 Health: (Routine area based data includes study households Int/Cont n=152/289)  Before v After Int Area/Cont Area Standardised death rates per 1000: 22.91/33.55 v 26.10/22.78 (Borough 12.32 v 12.07). Increased death rates reported to affect those from 10-65 years rather than those at the extremes of life.  Infant Mortality Rates (unclear if these were standardised) per 1000 live births 172.6/173.2 v 117.8/134.0. No report of infective epidemic.

 

Other: (Int/Cont n=35/30 families) Before v After Int/Cont rent as % of income 20.5%/14.7% v 31.3%/20.8%.  Survey reports shortage of main dietary constituents except carbohydrates.  Shortages greater in families in Int area. 90% unemployment in Int area after rehousing.



 
Table 10. Visual summary of effect direction for individual outcomes (correct version available from author)

Intervention: Warmth & energy efficiency improvements (post 1980)

Author YearStudy gradeHousing conditionGeneral health Respiratory Mental Illness/

symptoms
 











CHARISMA 2011 (sub-group: central heating/ventilation only)AΛPhysical healthOverall asthma scale (PedsQL)Overall psychosocial scale (PedsQL)











Osman et al 2010AEuroqual analogueaSGRQ totala    











     SGRQ impacta    











     SGRQ activitiesa    











Osman et al 2010 (sub-group: no/some intervention)   SGRQ symptomsa    










  Euroqual analogueaSGRQ totala    










    SGRQ impacta    










    SGRQ activitiesa    











     SGRQ symptomsa    











Howden-Chapman et al 2008 (children)APoor/fair healthSleep disturbed by wheeze  Diarrhoea











     Wheeze limits speech  Twisted ankle











     Wheeze during exercise  Vomiting











     Dry cough at night  Ear infection











     Cough at  night (diary)    











     Cough on waking (diary)    











     Cough during day (diary)    











     Cough overall    











     Lower resp symptoms    











     Upper resp symptoms    











     Wheeze overall    











Barton et al 2007 (adults & children)A◄►SF-36 domains<>Asthma prevalenceGHQΛArthritis










    BronchitisSF-36 domains<>Rheumatism











     ‘other’ respiratory conditions    











Barton et al 2007

(adults only- paired n=14/13 Int/Cont)
A◄►  Breathless on exercisea    










    Breathlessa    











     Wheeze (day)a    











     Wheeze (night)a    











     Cough (day)a    











     Cough (night)a    











     Mean asthma scorea    











Barton et al 2007  (children)A◄►  Breathless on exercisea    











     Breathlessa    











     Wheeze (day)a    











     Wheeze (night)a    











     Cough (day)a    











     Cough (night)a    











     Mean asthma scorea    











Howden-Chapman et al 2007AFair/poor healthWheezing in last 3 monthsRole emotional (SF-36)a  











   Social functioning (SF-36)SR cold/flu symptomsHappiness (SF-36)  











   Role physical (SF-36)aMorning  phlegmVitality (SF-36)  











Howden-Chapman et al 2007 (children)A  Sleep disturbed by wheezing    











     Speech disturbed by wheezing    











Braubach et al 2008AΛSelf-reported healthΛAsthma<>Depression customised score  

Common coldΛ











     Acute bronchitisΛ    











     Chronic bronchitisΛ    











Platt et al 2007AGeneral health (SF-36)aEver diagnosed nasal allergyMental health (SF-36)aEver diagnosed heart diseasea











   Physical functioning (SF-36)aOther respiratory symptoms<>Vitality (SF-36)aEver diagnosed hypertensiona











   Role physical (SF-36)aEver diagnosed asthmaaSocial function (SF-36)aBodily pain (SF-36)a











     Ever diagnosed bronchitisaRole emotional (SF-36)aCirculation problemsa











         Eczemaa











Lloyd et al 2008B       Blood pressurea











Shortt et al 2007B  AsthmaStress/mental illnessbAngina











     Chest infect’n/bronchitis  Arthritis /rheumatism











     Pneumonia/hypothermia (prevalence)  ‘other illness











Somerville et al 2000  (children)B  Cough by dayb  Diarrhoea◄► b

Cough by nightb











     Wheeze by nightb    











     Breathless with exerciseb    











     Breathlessb    











     Runny noseb    











     Blocked noseb    











     Hay fever◄► b    











Hopton et al 1996  (children)B  Persistent coughFeeling downMean number of symptomsV











     Runny noseIrritabilityTiredness











     WheezingTemper TantrumsAches & pains










        Vomiting











         Fever











         Headaches











         Poor appetite











         Diarrhoea











         Earache











         Sore throat











           











Allen 2005CΛ    GHQ scoreb  











Allen 2005 aCΛPhysical component SF-36b  Depression (HADS)b  











       Anxiety (HADS)b  











       SF-36 Mental componentb  











Health Action Kirklees Calderdale & Wakefield 2005CΛ      Improvement in medical conditionΛ b











           











Iversen et al 1986CΛ  Dry throatb  Rheumatic symptomsb











         Neck/back painb











         Eye irritationb











Intervention: Rehousing/retrofitting +/- neighbourhood improvement (post 1995)

Kearns et al 2008AGood healthWheeze in past yearMental health (SF-36)Smoker











   Long standing illness  Vitality (SF-36)Heavy drinker











   Health improved since last year  Social function (SF-36)5+ fruit & veg/day











       Role emotional (SF-36)Walked recently in n’hoodV











Kearns et al 2008 (sub-group: Some/No improved dwelling condition)  Physical functioning (SF-36)  Mental health (SF-36)◄► a  










      Vitality (SF-36)◄► a  










      Social function (SF-36)<> a  










      Role emotional (SF-36)◄► a  











Kearns et al 2008 (sub-group: Some/No improved dwelling suitability)      Mental health (SF-36)  










      Vitality (SF-36)  










      Social function (SF-36)  










      Role emotional (SF-36)  











Kearns et al 2008 (children)A  Asthma  Sleeping problem

Bronchitis

BreathlessnessEczema

Persistent coughChronic illness











     Sinus/Catarrh  Indigestion











     Hay fever  Headaches











Thomson et al 2007AFair/poor healtha  Mental component (SF-36)◄►a  











   SF-36 Physical componentb      











Critchley et al 2004AΛGeneral health (SF-36 domain)<> b  Mental health (SF-36 domain)<> b  











Critchley et al 2004 (sub-group: No/Some improvement in SAP) ΛSF-36 domainsΛ a  Energy & vitality (SF-36 domain)<> a  











Thomas et al 2005B<>    GHQ-12b  











Thomas et al 2005 (sub group: No/Some housing improvement) Λ    GHQ-12b  











Barnes et al 2003B◄►Fair/poor health  Anxiety/ depressionPain & discomfort











   Mobility problems  Optimism for future better than 1 year ago  


Health problems affecting daily activities











   Health problems better compared to 1 yr ago      











Evans et al 2002B<>General health (SF-36 domain)Λ      











   Physical function (SF-36)V      











Breysse et al 2011CHealth better since intervention◄►AsthmaInjuries◄►











Non-asthma respiratory symptoms











Breysse et al 2011 (children)Health better since intervention◄►Asthma symptoms◄►Injuries











Non-asthma respiratory symptoms











Molnar et al 2010CΛFunctional limitation<>b











HypertensionV b











Thrombosis<>b











Varicositas<>











Molnar et al 2010 (children)Epilepsy<>b











Brain tumour<>b











Spinal hernia<>b











Scabie/louse/impetigoΛ b











Blackman et al 2001C<>Health ‘not good’bChronic respiratory conditionbMental health problemb  











     Acute respiratory conditionb    











Blackman et al 2001 (children)C<>Parent reported good healthbParent reported chronic respiratory conditionbParent reported mental health problemb  











     Parent reported acute respiratory conditionb    











Wells 2000C  Parent reported acute respiratory conditionbPERI  











Ambrose 1999C  Asthma /bronchial conditionbStress/ depressionbAches & painsb











     Cough/coldb  Dietary/digestive problemb











         Illness episodes per dayV b











Halpern 1995C     Depression (HADS)b  











       Anxiety (HADS)b  











Intervention: Provision of basic housing needs/low or middle income country intervention

Spiegel et al 2003CΛSelf-reported health◄►











Rojas de Arias 1999 (housing improvement only group)BTriatomine +veb











Rojas de Arias 1999 (sub-group: male, housing improvement only)Triatomine +veb











Rojas de Arias 1999 (sub-group: female, housing improvement only)Triatomine +veb











Aziz et al 1990 * (children)CΛ      Diarrhoea episodes in past year











         Dysentery incidence











         Height for ageΛ











         Weight for ageV











         Height for weightV











Aziz et al 1990 * (children) (sub-group: use/don’t use latrine for defaecation)        Diarrhoea episodes in past year










        Height for age










        Weight for age










        Height for weight











Intervention: Rehousing from slums (pre 1970)

Wilner et al 1960AΛ    Positive moodaDisabilitya











       NervousnessaIllness episodesΛ b











       Optimisma  











       Satisfaction with status quoa  











Wilner et al 1960 (sub-group: no/some/considerable housing improvement) Λ    Satisfaction with status quoΛ  










      OptimismΛ  










      Feel better than 5 yrs agoΛ  











McGonigle et al 1936 *CΛ      Mortality rates (adult)V











         Infant mortality rateΛ











         Children diedΛ











Chapin 1938C<>    MoraleΛ b  











Chapin 1938 (sub-group: no/some reduction in overcrowding) Λ    Morale<>a  











 

* area level data not relating only to study population 

Effect direction: upward arrow= positive health impact, downward arrow= negative health impact, sideways arrow= mixed effects/conflicting findings

Sample size: Final sample size (individuals) in intervention group Large arrow >300; medium arrow 50-300; small arrow <50

Statistical significance: Black arrow p<0.05; grey arrow p>0.05; empty arrow= no statistics/data reported

Statistical tests: Controlled studies- Difference between control and intervention group at follow-up (unless stated); a Difference in change between control and intervention group; b Change within intervention group only; c Regression identifying predictor of change: Uncontrolled studies: Change since baseline

Outcomes reported for adults unless stated

 


 Important formatting features re size and colour of arrows have not been imported with this table- correct version available from author
 
Table 11. Follow-up times where more than once (since intervention unless stated)

StudyStudy quality1234

Warmth & energy efficiency studies

Experimental studies

CHARISMA 2011A3 months11 months

Non-experimental studies

Platt 2007 (since baseline)A1 years2 years  

Iversen 1986C1-4 months2-5 months3-6 months 

Rehousing/retrofitting

Non-experimental studies

Kearns 2008A9-12 months (no control group data)21-24 months  

Barnes 2003B6 months12 months18 months 

Breysse 2011C1-4 months12-18 months

Wells 2000C5-12 months2-3 years  

Provision of basic housing needs/low or middle income country

Non-experimental studies

Aziz 1990C1-2 years2-3 years8-9 years 

Rehousing from slums

Non-experimental studies

Wilner 1960 (since baseline)A9 months11 months13 months15/16/18 months

(<1 year since intervention)

 Bolded times indicate timepoint prioritised in narrative synthesis. All data extracted and reported in full data extraction (see Appendix 2)
 
Table 12. Summary of standardised effect estimates

StudyStudy size Int/Con

(Time since

intervention)
Study

grade
Specific outcomeOdds ratio for

intervention group (95% CI)

Intervention: Warmth & Energy Efficiency improvements (post 1985)

General health: Experimental studies (n=2)   




Howden-Chapman 2008(children)175/174 (4-5 months)APoor/fair self-reported health0.480 (0.310 to 0.740)*** adj

Howden-Chapman 20071689/1623 (<1 year)APoor/fair self-reported health0.589 (0.467 to 0.743)*** adj

Respiratory: Experimental studies (n=3)   




Howden-Chapman 2008 (children)175/174 (4-5 months)ASleep disturbed by wheeze0.550 (0.350 to 0.850)*** adj

   Speech disturbed by wheezing0.690 (0.400 to 1.180) adj

   Dry cough at night0.520 (0.320 to 0.830)* adj

   Wheeze during exercise0.670 (0.420 to 1.060) adj

Barton 2007 (adults & children)193/254 (<2 years)AAsthma˜0.946 (0.598 to 1.496)

   Bronchitis˜1.007 (0.477 to 2.127)

   Other respiratory symptoms˜1.010 (0.560 to 1.820)

Howden-Chapman 2007965/961 (<1 year)AMorning phlegm0.640 (0.523 to 0.784)*** adj

Howden-Chapman 2007 (children & adults) 1689/1623 (<1 year) AWheezing in past 3 months0.570 (0.467 to 0.696)*** adj

   Cold/flu0.545 (0.430 to 0.691)*** adj

Howden-Chapman 2007 (children)512/471 (<1 year) Sleep disturbed by wheeze0.570 (0400 to 0.812)** adj

   Speech disturbed by wheezing0.514 (0.310 to 0.852)* adj

Respiratory: Non-experimental studies (n=2)   




Platt 20071281/1084 (1-2 years)AEver diagnosed nasal allergy1.520 (1.050 to 2.200)* adj

Ever diagnosed asthma0.92 (0.63 to 1.34) adj

Ever diagnosed bronchitis1.29 (0.97 to 1.72) adj

Shortt 200746/54 (1-3.5 years)B Asthma Ŧ˜0.568 (0.099 to 3.254)

   Chest infection/bronchitis Ŧ˜1.875 (0.495 to 7.102)

   Pneumonia/hypothermia Ŧ˜3.593 (0.143 to 90.361)

Hopton 1996 (children)55/77 (5-11 months)B Persistent cough˜0.973 (0.441 to 2.149)

Runny nose˜0.686 (0.337 to 1.394)

Wheezing˜1.125 (0.467 to 2.708)

Mental health: Experimental studies (n=1)   




Howden-Chapman 2007977/964 (<1 year)ALow happiness (SF-36)0.560 (0.409 to 0.767)*** adj

  ALow vitality (SF-36)0.510 (0.408 to 0.637)*** adj

Mental health: Non-experimental studies (n=2)   




Braubach 2008˜210/165 (5-8 months)ADepression1.404 (0.329 to 5.987)

Shortt 200746/54 (1-3.5 years)B Stress/Mental illness˜0.261 (0.053 to 1.299)

Hopton 1996 (children)55/77 (5-11 months)B Feeling down˜0.663 (0.233 to 1.891)

Irritability˜1.545 (0.569 to 4.196)

Temper tantrums˜0.973 (0.441 to 2.149)

Illness/symptom: Experimental studies (n=2)   




Howden-Chapman 2008 (children)175/174 (4-5 months)ADiarrhoea0.720 (0.450 to 1.160) adj

   Ear infection1.160 (0.680 to 1.990) adj

   Vomiting0.880 (0.550 to 1.400) adj

Twisted ankle1.86 (1.03 to 3.35)*

Barton 2007193/254 (<2 years)AArthritis˜1.058 (0.533 to 2.100)

   Rheumatism˜1.908 (0.829 to 4.395)

Illness/symptom: Non-experimental studies (n=2)   




Platt 20071281/1084 (1-2 years)AEver diagnosed hypertension0.770 (0.610 to 0.972)* adj

   Ever diagnosed heart disease0.690 (0.520 to 0.916)* adj

Ever diagnosed circulation problem1.06 (0.83 to 1.34) adj

Ever diagnosed eczema1.43 (0.89 to 2.28) adj

Shortt 200746/54 (1-3.5 years)B ‘Other’ illnesses Ŧ˜0.568 (0.099 to 3.254)

   Arthritis Ŧ˜1.619 (0.343 to 7.641)

   Angina Ŧ˜0.200 (0.041 to 0.966)*

Hopton 1996 (children)55/77 (5-11 months)B Aches & pains˜1.537 (0.664 to 3.555)

Diarrhoea˜0.735 (0.254 to 2.123)

Earache˜0.977 (0.347 to 2.749)

Fever˜0.784 (0.328 to 1.875)

Headaches˜0.681 (0.233 to 1.986)

Poor appetite˜0.342 (0.146 to 0.803)**

Sore throat˜1.355 (0.668 to 2.747)

Vomiting˜0.963 (0.380 to 2.443)

Tiredness˜1.524 (0.644 to 3.607)

Intervention: Rehousing/Retrofitting +/- neighbourhood renewal (post 1995)

General health: Non-experimental studies (n=3)   




Kearns 2008262/284 (2 years)ASelf-reported poor health0.769 (0.500 to 1.176) adj

   Long standing illness0.680 (0.440 to 1.050) adj

   Health not improved since 1 year ago0.787 (0.541 to 1.163) adj

Thomson 200750/50 (1 year)AFair/poor health1.757 (0.777 to 3.973)

   Lower SF-36 Physical Component Score0.960 (0.437 to 2.110)

Barnes 200345/45 (18 months)B Fair/poor health˜0.273 (0.110 to 0.682)*

   Health somewhat/much worse than 1 year ago˜0.356 (0.135 to 0.942)

   Health interferes with daily activities˜1.516 (0.617 to 3.730)

   Physical/emotional problems with daily life (in past 4 weeks)˜0.338 (0.138 to 0.829)

Respiratory: Non-experimental studies (n=1)   




Kearns 2008262/284 (2 years)AWheezing in past year1.040 (0.690 to 1.560) adj

Kearns 2008  (children)221/208 (2 years)AAsthma1.039 (0.650 to 1.661)

   Breathlessness1.185 (0.459 to 3.063)

   Persistent cough1.093 (0.663 to 1.800)

   Bronchitis0.311 (0.032 to 3.010)

   Sinus/catarrh0.890 (0.480 to 1.650)

Mental health: Non-experimental studies (n=2)   




Thomson 200750/50 (1 year)ALower SF-36 Mental Component Score0.733 (0.333 to 1.613)

Barnes 200345/45 (18 months)B Anxiety/Depression self reported˜0.361 (0.152 to 0.856)*

Illness/symptom: Non-experimental studies (n=2)   




Kearns 2008262/284 (2 years)ASmoker1.470 (0.849 to 2.546) adj

   Heavy drinker0.610 (0.300 to 1.240) adj

   Less than 5 portions fruit/veg per day0.794 (0.519 to 1.215) adj

Kearns 2008  (children)221/208 (2 years)AChronic illness1.039 (0.549 to 1.966)

   Headaches0.991 (0.604 to 1.626)

   Indigestion0.941 (0.058 to 15.145)

   Sleeping problems1.128 (0.618 to 2.059)

   Eczema1.148 (0.683 to 1.931)

   Hay fever0.990 (0.513 to 1.913)

Barnes 200345/45 (18 months)B Pain & discomfort˜0.400 (0.170 to 0.940)

   Mobility˜0.533 (0.215 to 1.322)


Mental health: Non-experimental studies (n=1)   




Wilner 19601891/2893 (<1 year)ANervousness˜1.157 (0.890 to 1.504)

   Negative mood˜0.912 (0.704 to 1.182)

   Dissatisfaction with status quo˜0.863 (0.663 to 1.122)

   Potency (nothing can be done to improve situation˜0.814 (0.628 to 1.055)

   Pessimism˜0.815 (0.628 to 1.056)

   Emotionality (not able to control of temper)˜0.796 (0.613 to 1.034)

Illness/symptom: Non-experimental studies (n=1)   




Wilner 19601891/2893 (<1 year)AAt least 1 day disability˜1.145 (0.977 to 1.342)

 * p<0.05, ** p<0.01, *** p<0.001 Ŧ proportion of households as opposed to individuals adj adjusted for key confounders (listed in data & analysis section)
 Inadequate control for confounding Grade C/key confounder emerged in analysis
˜ estimated OR as no indication of missing data for specific outcomes, or estimated sample size