Somerville M, Mackenzie I, Owen P, Miles D
Department of Public Health Medicine, Cornwall and Isles of Scilly Health Authority, John Keay House, St Austell, Cornwall PL25 4NQ, UK.
Public Health. 2000 Nov;114(6):434-9. doi: 10.1038/sj.ph.1900687.
The objective of this study was to evaluate the use of NHS money to improve health by improving housing conditions. A pilot study assessing health outcomes before and after improving housing conditions was conducted, studying 72 children with previously diagnosed asthma living in 59 damp houses in Cornwall. The intervention was the installation of central heating. This improved the energy efficiency of the housing. The children's health was a symptom-based outcome measure for asthma and time lost from school. Improvements comprised installation of gas central heating in 28/59 (47%) houses, electric storage heaters in 22/59 (37%), solid fuel central heating in 7/59 (12%) and oil-fired central heating in 2/59 (4%) houses. Energy efficiency improved by a mean of 2.1 on the National Home Energy Rating scale (95% CI 1.68-2.47, P<0.001) in the 37/59 (62%) houses for which two readings were available. Initially, 69/72 (92%) children's bedrooms were unheated and 44/72 (61%) were damp; following improvements, the proportions were 10/72 (14%) and 15/72 (21%) respectively. All respiratory symptoms were significantly reduced after intervention; the greatest reduction was seen in nocturnal cough from a median score of 3 (most nights) to 1 (on one or several nights) (P<0.001) in the previous month. School-age children lost significantly less time from school for asthma in the previous 3 months (9.3 days per 100 school days before intervention and 2.1 days afterwards, P<0.01) but not for other reasons (1.4 days per 100 school days before and 3.2 after, P>0.05). In conclusion, this study provides the first evaluation of health outcomes following housing improvements. Lack of a comparison group means that effects of age, season and biased reporting cannot be eliminated. More work is needed to substantiate these results.
本研究的目的是评估利用英国国家医疗服务体系（NHS）的资金通过改善住房条件来增进健康的情况。开展了一项试点研究，评估改善住房条件前后的健康结果，研究对象为康沃尔郡59所潮湿房屋中72名先前被诊断患有哮喘的儿童。干预措施是安装中央供暖系统。这提高了房屋的能源效率。儿童健康是以哮喘的症状为基础的结果指标以及缺课时间。改善措施包括在28/59（47%）的房屋中安装燃气中央供暖系统，在22/59（37%）的房屋中安装储电式加热器，在7/59（12%）的房屋中安装固体燃料中央供暖系统，在2/59（4%）的房屋中安装燃油中央供暖系统。在有两次读数的37/59（62%）的房屋中，国家家庭能源评级量表上的能源效率平均提高了2.1（95%置信区间1.68 - 2.47，P<0.001）。最初，69/72（92%）儿童的卧室没有供暖，44/72（61%）潮湿；改善后，这两个比例分别为10/72（14%）和15/72（21%）。干预后所有呼吸道症状均显著减轻；上个月夜间咳嗽的减轻最为明显——中位数评分从3（大多数夜晚）降至1（一个或几个夜晚）（P<0.001）。学龄儿童在之前3个月因哮喘缺课的时间显著减少（干预前每100个上学日缺课9.3天，干预后为2.1天，P<0.01），但因其他原因缺课的时间没有显著变化（干预前每100个上学日缺课1.4天，干预后为3.2天，P>0.05）。总之，本研究首次评估了住房改善后的健康结果。缺乏对照组意味着年龄、季节和报告偏差的影响无法消除。需要开展更多工作来证实这些结果。
