Housing interventions and health: Quantifying the impact of indoor particles on mortality and morbidity with disease recovery

James Milner*, Zaid Chalabi, Sotiris Vardoulakis, Paul Wilkinson

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

3 Citations (Scopus)


Housing interventions for energy efficiency and greenhouse gas emission reduction have the potential to reduce exposure to indoor air pollution if they are implemented correctly. This work assessed the health impacts of home energy efficiency measures in England and Wales resulting in a reduction in average indoor PM2.5 exposures of 3μgm-3. The assessment was performed using a new multistate life table model which allows transition into and between multiple morbid states, including recovery to disease-free status and relapse, with transition rates informed by age- and cause-specific disease prevalence, incidence and mortality data. Such models have not previously included disease recovery. The results demonstrate that incorporation of recovery in the model is necessary for conditions such as asthma which have high incidence in early life but likelihood of recovery in adulthood. The impact assessment of the home energy efficiency intervention showed that the reduction in PM2.5 exposure would be associated with substantial benefits for mortality and morbidity from asthma, coronary heart disease and lung cancer. The overall impact would be an increase in life expectancy of two to three months and approximately 13 million QALYs gained over the 90year follow-up period. Substantial quality-of-life benefits were also observed, with a decrease in asthma over all age groups and larger benefits due to reduced coronary heart disease and lung cancer, particularly in older age groups. The multistate model with recovery provides important additional information for assessing the impact on health of environmental policies and interventions compared with mortality-only life tables, allowing more realistic representation of diseases with substantial non-mortality burdens.

Original languageEnglish
Pages (from-to)73-79
Number of pages7
JournalEnvironment International
Publication statusPublished - 1 Aug 2015

Bibliographical note

Funding Information:
This work, including development of the health impact model, was conducted as part of the project “Pollutants in the Urban Environment: An Integrated Framework for Improving Sustainability of the Indoor Environment (PUrE Intrawise)”, funded by EPSRC (Grant no. EP/F007132/1 ). The authors gratefully acknowledge this funding and the support of other project partners. The research leading to these results has also in part received funding from the European Union Seventh Framework Programme FP7/2007–2013 under grant agreement no 265325 (“PURGE”).

Publisher Copyright:
© 2015 Elsevier Ltd.

Copyright 2020 Elsevier B.V., All rights reserved.


  • Disease recovery
  • Health impact assessment
  • Indoor air pollution
  • Particulate matter
  • Quality of life


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