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Damp mouldy housing and early childhood hospital admissions for acute respiratory infection: a case control study
  1. Tristram Ingham, Senior Research Fellow1,
  2. Michael Keall2,
  3. Bernadette Jones1,
  4. Daniel R T Aldridge1,
  5. Anthony C Dowell3,
  6. Cheryl Davies4,
  7. Julian Crane1,
  8. Jessica Barbara Draper1,4,
  9. Lauren Olivia Bailey1,
  10. Helen Viggers2,
  11. Thorsten Villiers Stanley5,6,
  12. Philip Leadbitter7,
  13. Mereana Latimer4,
  14. Philippa Howden-Chapman2
  1. 1 Department of Medicine, University of Otago Wellington, Wellington, New Zealand
  2. 2 Department of Public Health, University of Otago Wellington, Wellington, New Zealand
  3. 3 Department of Obstetrics and Gynaecology, University of Otago Wellington, Wellington, New Zealand
  4. 4 Tu Kotahi Māori Asthma Trust, Lower Hutt, New Zealand
  5. 5 Department of Paediatrics, University of Otago Wellington, Wellington, New Zealand
  6. 6 Department of Paediatrics, Capital and Coast District Health Board, Wellington, New Zealand
  7. 7 Department of Paediatrics, Hutt Valley District Health Board, Lower Hutt, New Zealand
  1. Correspondence to Dr Tristram Ingham, Department of Medicine, University of Otago Wellington, Wellington 6242, New Zealand; tristram.ingham{at}


Introduction A gap exists in the literature regarding dose–response associations of objectively assessed housing quality measures, particularly dampness and mould, with hospitalisation for acute respiratory infection (ARI) among children.

Methods A prospective, unmatched case–control study was conducted in two paediatric wards and five general practice clinics in Wellington, New Zealand, over winter/spring 2011–2013. Children aged <2 years who were hospitalised for ARI (cases), and either seen in general practice with ARI not requiring admission or for routine immunisation (controls) were included in the study. Objective housing quality was assessed by independent building assessors, with the assessors blinded to outcome status, using the Respiratory Hazard Index (RHI), a 13-item scale of household quality factors, including an 8-item damp–mould subscale. The main outcome was case–control status. Adjusted ORs (aORs) of the association of housing quality measures with case–control status were estimated, along with the population attributable risk of eliminating dampness–mould on hospitalisation for ARI among New Zealand children.

Results 188 cases and 454 controls were studied. Higher levels of RHI were associated with elevated odds of hospitalisation (OR 1.11/unit increase (95% CI 1.01 to 1.21)), which weakened after adjustment for season, housing tenure, socioeconomic status and crowding (aOR 1.04/unit increase (95% CI 0.94 to 1.15)). The damp–mould index had a significant, adjusted dose–response relationship with ARI admission (aOR 1.15/unit increase (95% CI 1.02 to 1.30)). By addressing these harmful housing exposures, the rate of admission for ARI would be reduced by 19% or 1700 fewer admissions annually.

Conclusions A dose–response relationship exists between housing quality measures, particularly dampness–mould, and young children’s ARI hospitalisation rates. Initiatives to improve housing quality and to reduce dampness–mould would have a large impact on ARI hospitalisation.

  • acute respiratory infections
  • housing quality
  • dampness
  • mould
  • public health policy
  • child health

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  • Contributors TI, MK, BJ, CD, JC, HV, TVS and PHC developed the study design and secured all grant funding. TI, BJ, CD, JBD, LOB and PL undertook the data collection. TI, MK and DRA were responsible for data analysis. TI, MK, BJ, DRTA and PHC undertook the literature review and drafted the manuscript. TI, MK, BJ, JC, TD, CD, DRTA, HV, TVS, PL, ML and PH-C provided critical input in the interpretation of the results. All authors reviewed and contributed to the manuscript. All authors, external and internal, had full access to all of the data (including statistical reports and tables) in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis. TI is the guarantor.

  • Funding This study was supported by grants from the Health Research Council (HRC) of New Zealand (HRC Refs: 10/443 and 11/370). The funding organisation had no role in the design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review or approval of the manuscript; and decision to submit the manuscript for publication.

  • Competing interests All authors have completed the International Committee of Medical Journal Editors uniform disclosure form at and declare the following: TI reports grants from the Health Research Council of New Zealand during the conduct of the study, grants from Janssen Research and Development, and others from AstraZeneca outside the submitted work. MK, CD, JC, HV and ML report grants from the Health Research Council of New Zealand during the conduct of the study. BJ, DRTA, JBD and LOB report grants from the Health Research Council of New Zealand during the conduct of the study and grants from Janssen Research and Development outside the submitted work. ACD, TVS and PI report that they have nothing to disclose. PH-C reports grants from the Health Research Council of New Zealand and the Ministry of Business, Innovation and Employment during the conduct of the study. The lead author affirms that this manuscript is an honest, accurate and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned have been explained.

  • Patient consent for publication Not required.

  • Ethics approval This study was approved by the New Zealand Health and Disability Ethics Committee (Northern B) MEC/11/01/008.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.