Journal of Public Health Advance Access originally published online on September 9, 2005
Journal of Public Health 2005 27(4):353-358; doi:10.1093/pubmed/fdi051
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Excess winter morbidity among older people at risk of cold homes: a population-based study in a London borough
Janet Rudge
Janet Rudge, Research Fellow, Department of Architecture and Spatial Design, Low Energy Architecture Research Unit (LEARN), London Metropolitan University, Spring House, 40–44 Holloway Road, London N7 8JL, UK
Robert Gilchrist
Robert Gilchrist, Director, The Statistics, Operational Research and Mathematics Research Centre (STORM), London Metropolitan University, 2–16 Eden Grove, London N7 8EA, UK
Address correspondence to Janet Rudge. Email: j.rudge{at}londonmet.ac.uk
Background Fuel poverty frequently affects older low-income households, in homes that are difficult to heat. Excess winter deaths occurring in Britain are widely attributed to effects of cold. This pilot study examined the demonstrability of a relationship between older people’s health and fuel poverty risk, using morbidity data.
Methods An observational, population-based study was made of 25 000 residents aged 
65 years in the London Borough of Newham (LBN). Using Hospital Episode Statistics (HES) data over 1993–1997, anonymized at enumeration district (ED) level, we calculated excess winter morbidity, based on emergency hospital episodes for all respiratory diagnosis codes. EDs were variously aggregated after ranking against a proposed Fuel Poverty Risk Index (FPR), including factors of energy inefficient housing, low income, householder age and under occupation.
Results FPR is a predictor of excess winter morbidity. In particular, FPR was observed showing a significant relationship with high winter morbidity counts for 2 of 4 years studied. Using FPR as a two-level factor (high and non-high), the model provides odds ratios: for 1993, winter/summer morbidity ratio for high FPR is 1.7 higher than the corresponding ratio for non-high FPR [95% confidence interval (CI)=1.1–2.7], and for 1996, the odds ratio is 1.6 (95% CI=0.9–2.8). In a regression with grouped EDs, having allowed for FPR, no other variables in our set contribute to the difference between winter and summer morbidity counts.
Conclusions Results may indicate supporting evidence of a relationship between energy inefficient housing and winter respiratory disease among older people, with public health implications for increasing health-driven energy efficiency housing interventions.
Keywords: cold, excess winter morbidity, housing, older people