The impact of energy retrofits on pediatric asthma exacerbation in a Boston multi-family housing complex: a systems science approach

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Abstract

Background

Pediatric asthma is currently the most prevalent chronic disease in the United States, with children in lower income families disproportionately affected. This increased health burden is partly due to lower-quality and insufficient maintenance of affordable housing. A movement towards ‘green’ retrofits that improve energy efficiency and increase ventilation in existing affordable housing offers an opportunity to provide cost-effective interventions that can address these health disparities.

Methods

We combine indoor air quality modeling with a previously developed discrete event model for pediatric asthma exacerbation to simulate the effects of different types of energy retrofits implemented at an affordable housing site in Boston, MA.

Results

Simulation results show that retrofits lead to overall better health outcomes and healthcare cost savings if reduced air exchange due to energy-saving air tightening is compensated by mechanical ventilation. Especially when exposed to indoor tobacco smoke and intensive gas-stove cooking such retrofit would lead to an average annual cost saving of over USD 200, while without mechanical ventilation the same children would have experienced an increase of almost USD 200/year in health care utilization cost.

Conclusion

The combination of indoor air quality modeling and discrete event modeling applied in this paper can allow for the inclusion of health impacts in cost-benefit analyses of proposed affordable housing energy retrofits.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12940-021-00699-x.

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Most cited references 42

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The role of acute and chronic stress in asthma attacks in children.

D McGuinness, S Ahola, Warren Sandberg … (2000)

High levels of stress have been shown to predict the onset of asthma in children genetically at risk, and to correlate with higher asthma morbidity. Our study set out to examine whether stressful experiences actually provoke new exacerbations in children who already have asthma. A group of child patients with verified chronic asthma were prospectively followed up for 18 months. We used continuous monitoring of asthma by the use of diaries and daily peak-flow values, accompanied by repeated interview assessments of life events and long-term psychosocial experiences. The key measures included asthma exacerbations, severely negative life events, and chronic stressors. Severe events, both on their own and in conjunction with high chronic stress, significantly increased the risk of new asthma attacks. The effect of severe events without accompanying chronic stress involved a small delay; they had no effect within the first 2 weeks, but significantly increased the risk in the subsequent 4 weeks (odds ratio 1.71 [95% CI 1.04-2.82], p < or = 0.05 for weeks 2-4 and 2.17 [1.32-3.57], p < or = 0.01 for weeks 4-6). When severe events occurred against the backdrop of high chronic stress, the risk increased sharply and almost immediately within the first fortnight (2.98 [1.20-7.38], p < or = 0.05). The overall attack frequency was affected by several factors, some related to asthma and some to child characteristics. Female sex, higher baseline illness severity, three or more attacks within 6 months, autumn to winter season, and parental smoking were all related to increased risk of new exacerbations; social class and chronic stress were not. Severely negative life events increase the risk of children's asthma attacks over the coming few weeks. This risk is magnified and brought forward in time if the child's life situation is also characterised by multiple chronic stressors.

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Health effects of home energy efficiency interventions in England: a modelling study

Ian Hamilton, James Milner, Zaid Chalabi … (2015)

Objective To assess potential public health impacts of changes to indoor air quality and temperature due to energy efficiency retrofits in English dwellings to meet 2030 carbon reduction targets. Design Health impact modelling study. Setting England. Participants English household population. Intervention Three retrofit scenarios were modelled: (1) fabric and ventilation retrofits installed assuming building regulations are met; (2) as with scenario (1) but with additional ventilation for homes at risk of poor ventilation; (3) as with scenario (1) but with no additional ventilation to illustrate the potential risk of weak regulations and non-compliance. Main outcome Primary outcomes were changes in quality adjusted life years (QALYs) over 50 years from cardiorespiratory diseases, lung cancer, asthma and common mental disorders due to changes in indoor air pollutants, including secondhand tobacco smoke, PM2.5 from indoor and outdoor sources, radon, mould, and indoor winter temperatures. Results The modelling study estimates showed that scenario (1) resulted in positive effects on net mortality and morbidity of 2241 (95% credible intervals (CI) 2085 to 2397) QALYs per 10 000 persons over 50 years follow-up due to improved temperatures and reduced exposure to indoor pollutants, despite an increase in exposure to outdoor-generated particulate matter with a diameter of 2.5 μm or less (PM2.5). Scenario (2) resulted in a negative impact of −728 (95% CI −864 to −592) QALYs per 10 000 persons over 50 years due to an overall increase in indoor pollutant exposures. Scenario (3) resulted in −539 (95% CI −678 to -399) QALYs per 10 000 persons over 50 years follow-up due to an increase in indoor exposures despite the targeting of pollutants. Conclusions If properly implemented alongside ventilation, energy efficiency retrofits in housing can improve health by reducing exposure to cold and air pollutants. Maximising the health benefits requires careful understanding of the balance of changes in pollutant exposures, highlighting the importance of ventilation to mitigate the risk of poor indoor air quality.

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Costs of asthma in the United States: 2002-2007.

Sarah Beth L Barnett, Tursynbek A. Nurmagambetov (2011)

The economic burden of asthma is an important measure of the effect of asthma on society. Although asthma is a costly illness, the total cost of asthma to society has not been estimated in more than a decade. The purpose of this study is to provide the public with current estimates of the incremental direct medical costs and productivity losses due to morbidity and mortality from asthma at both the individual and national levels for the years 2002-2007. Data came from the Medical Expenditure Panel Survey. Two-part models were used to estimate the incremental direct costs of asthma. The incremental number of days lost from work and school was estimated by negative binomial regressions and valued following the human capital approach. Published data were used to value lives lost with an underlying cause of asthma. Over the years 2002-2007, the incremental direct cost of asthma was $3,259 (2009 dollars) per person per year. The value of additional days lost attributable to asthma per year was approximately $301 for each worker and $93 for each student. For the most recent year available, 2007, the total incremental cost of asthma to society was $56 billion, with productivity losses due to morbidity accounting for $3.8 billion and productivity losses due to mortality accounting for $2.1 billion. The current study finds that the estimated costs of asthma are substantial, which stresses the necessity for research and policy to work toward reducing the economic burden of asthma. Copyright Â© 2010 American Academy of Allergy, Asthma & Immunology. Published by Mosby, Inc. All rights reserved.

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Author and article information

Contributors

Koen F. Tieskens:

ORCID: http://orcid.org/0000-0002-6917-6069

tieskens@bu.edu

Chad W. Milando: cmilando@bu.edu

Lindsay J. Underhill: lju@bu.edu

Kimberly Vermeer: kim.vermeer@urbanhabitatinitiatives.com

Jonathan I. Levy: jonlevy@bu.edu

M. Patricia Fabian: pfabian@bu.edu

Journal

Journal ID (nlm-ta): Environ Health

Journal ID (iso-abbrev): Environ Health

Title: Environmental Health

Publisher: BioMed Central (London )

ISSN (Electronic): 1476-069X

Publication date (Electronic): 14 February 2021

Publication date PMC-release: 14 February 2021

Publication date Collection: 2021

Volume: 20

Electronic Location Identifier: 14

Affiliations

[1 ]GRID grid.189504.1, ISNI 0000 0004 1936 7558, Department of Environmental Health, , Boston University School of Public Health, ; 715 Albany Street, Boston, MA 02118 USA

[2 ]Urban Habitat Initiatives Inc, 328A Tremont Street, Boston, MA 02116 USA

Author information

Koen F. Tieskens http://orcid.org/0000-0002-6917-6069

Article

Publisher ID: 699

DOI: 10.1186/s12940-021-00699-x

PMC ID: 7883428

PubMed ID: 33583411

SO-VID: 33e586c3-77c6-41d8-b213-3a6479820ae3

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 15 September 2020

Date accepted : 1 February 2021

Funding

Funded by: U. S. Department of Housing and Urban Development

Award ID: MAHHU0008- 12

Award Recipient : M. Patricia Fabian

Funded by: National Institute of Environmental Health Sciences

Award ID: NIEHS T32 ES01456

Award ID: NIEHS/NIH R01 ES027816

Award Recipient : M. Patricia Fabian

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ScienceOpen disciplines: Public health

Keywords: indoor air quality,discrete event model,energy retrofit,pediatric asthma,systems science

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ScienceOpen disciplines: Public health

Keywords: indoor air quality, discrete event model, energy retrofit, pediatric asthma, systems science

The impact of energy retrofits on pediatric asthma exacerbation in a Boston multi-family housing complex: a systems science approach

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Abstract

Background

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Conclusion

Supplementary Information

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Most cited references 42

The role of acute and chronic stress in asthma attacks in children.

Health effects of home energy efficiency interventions in England: a modelling study

Costs of asthma in the United States: 2002-2007.

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