Association Between Mould/Dampness in the Home and Health Status of the Inhabitants

P. Rudnai1, M.J.Varró1, T. Málnási1, A. Páldy1, S. Nicol2, A. O’Dell2, M. Braubach3, X. Bonnefoy3

1National Institute of Environmental Health, Hungary

2Building Research Establishment, United Kingdom

3WHO ECEH Bonn Office

Sources of Dampness in Dwellings

A warm, dry well-ventilated home is the ideal. But many are damp:

Rising Damp Capillary action of ground water into the structure

Penetrating Damp Of rain/melt water through the roof, walls, or joints

Condensation Usually generated internally by household through cooking, clothes drying,

bathing and breathing.

Rising Damp

Penetrating Damp

Serious Condensation

THE „LARES” STUDY (2002-03) Angers 880 Bonn 946 Bratislava 892 Budapest 1086 Ferreira 1055 Forli 1157 Geneva 710 Vilnius 1793

Altogether 8519 persons interviewed

Dampness/Mould Related Data from WHO LARES Study

Mould growth: surveyor’s assessment extent (room by room): seriousness

Smell, condensation: surveyor’s assessment extent (room by room): whether present

Mould growth: householder’s views rooms: frequency: duration

Dampness / condensation: householder’s views Rooms: frequency: duration

Information combined to produce index of likelihood and severity: No mould/dampness Little mould/dampness Some mould/dampness Much mould /dampness

Distribution of homes by mould categories in the LARES Study

52,4

14,8 16,2 16,6

0

10

20

30

40

50

60%

Nomould/dampness

Littlemould/dampness

Somemould/dampness

Muchmould/dampness

‘Much mould / dampness’ by LARES cities

0,00 5,00 10,00 15,00 20,00 25,00 30,00 35,00 40,00 45,00 50,00

Angers

Bonn

Bratislava

Budapest

Ferreira

Forli

Geneva

Vilnius

Total

City

Percentage

Explanation for dampness

Wide variation in dampness between 8 LARES cities

Main factors: Disrepair, lack of central heating, home perceived as cold in winter.

These factors are good predictors of dampness in each city

Model predicts Geneva as best, Ferreira as worst, and most in-between.

‘City’ is still a factor.

The Relationship Between Illness and Dampness

Relationship explored by plotting persons affected by the different illnesses against the damp/mould index

Criterion for an association: Doctor diagnosed diseases and symptoms Significant association, using tabulation and logistic regression

(bi and multi-variant) using STATA 7.0 program.

Evidence of a dose effect

Prevalences of some chronic diseases by mould/dampness categories

5

13,2

4,8

13,514,8

3,2 2,6

6,1**

3,7

15,8*

7,7***

4,5*

0

2

4

6

8

10

12

14

16

18

asthma bronchitis arthrosis, arthritis

%

no mould/dampness

little mould/dampness

some mould/dampness

much mould/dampness

ASTHMA

*p<0.05 **p<0.01 ***p<0.001

Prevalences of some chronic diseases by mould/dampness categories

4,6

6,4

13,8

8,6**

18,1***

6*

11,2***

19,4***

6,9**

14,2***

23***

9,6***

0

5

10

15

20

25

Anxiety anddepression

Depression (Salsa) Migraine

%

no mould/dampness

little mould/dampness

some mould/dampness

much mould/dampness

*p<0.05 **p<0.01 ***p<0.001

Prevalences of people with some acute illnesses in the last 12 months

5,4

32,8

6,8

34,1

7,8**

39,3***

8,1***

41,7***

0

5

10

15

20

25

30

35

40

45

diarrhoeal disease cold/throat illness

%

no mould/dampness

little mould/dampness

some mould/dampness

much mould/dampness

*p<0.05 **p<0.01 ***p<0.001

Prevalences of some symptoms during the last 12 months by mould/dampness categories

1,4

5,3

8,27,6

5,3

1,1

6,57,1*

10* 10,3**

8,6**

11,9*** 11,2***

7,6**

2,5**

11,9***

13,8***

15,5***

8,1***

2,7***

0

2

4

6

8

10

12

14

16

18

astma attack wheeze eczema wateryeyes/eye

inflammation

headache

%

no mould/dampness

Little mould/dampness

some mould/dampness

much mould/dampness

*p<0.05 **p<0.01 ***p<0.001

Adjusted odds ratios* of some chronic and acute diseases among people living in homes with much

mould/dampness (vs. no mould/dampness)

0

0,5

1

1,5

2

2,5

3a

sth

ma

bro

nc

hit

is

art

hri

tis

/art

hro

sis

an

xie

ty/d

ep

res

sio

n

de

pre

ss

ion

(s

als

a)

mig

rain

e

co

ld/t

hro

at

illn

es

s

dia

rrh

oe

a

Od

ds

Ra

tio

*Adjusted to age, sex, SES, city, smoking and ETS

Adjusted odds ratios* of the prevalence of some symptoms in the last 12 months among people living in homes with much

mould/dampness (vs. no mould/dampness)

0

0,5

1

1,5

2

2,5

3

3,5

4

asthma attack wheeze eczema conjunctivitis headache

Od

ds

Rat

io

*Adjusted to age, sex, SES, city, smoking and ETS

Results: Apparent associations

Significant associations: Asthma/asthma attack Chronic bronchitis Arthrosis and arthritis Anxiety and depression Depression (Salsa) Migraine Diarrhoeal disease Cold/throat illness Wheezing/whistling in the chest Eczema Watery eyes/eye inflammation Headache

diabeteshypertensionherat attackstrokemalignant tumourasthmachronic bronchitisrheumatic arthritisanxiety / depressionmigraine / headachesskin diseasesallergy (exc asthma)osteoporosiscataractgastric ulcertuberculosis

cold / throat illnessbronchitis / pneumoniadiarrhoeal disease

chest wheezingasthma attacknasal allergiessneezing / runny noseeczema / skin allergyfatigueheadachewatery eyes / inflammation

bad or worse health

strong negative feelings

Explanations ?

Apparent associations with emotional / mental conditions and cold-like symptoms

Relationship does not imply anything about cause and effect Relationships:

dampness … illness dampness … ‘poor housing’ … illness dampness … ‘poor housing’ … human factors … illness

Poor housing is typically lived in by old persons, households with limited means, less education/access to employment.

Dissatisfaction (or actual illness) experienced by vulnerable persons within these households may have given rise to these effects.

LARES analysis shows that vulnerable people are more likely to suffer from anxiety/depression, but the analysis still indicates a residual ‘dampness/mould’ effect

Conclusions

LARES contains reasonable measures of dampness consistency between household / surveyor views and mould /

dampness

Dampness is a significant problem, although considerable city-to-city variations partially explainable some ‘city’ component remaining

Dampness / illness findings consistent with other studies, although difficult to quantify due to small sample sizes

‘Definite’ relationships: emotional / mental conditions and ‘cold-like’ symptoms - others not ruled out ‘poor housing’ and human factors may mediate LARES supports the view that people with poor health and negative

well being are more likely to live in poor housing.

Thank you for Thank you for

your attentionyour attention

Recommendations for Governments/Agencies

Governments have a responsibility to remove/reduce risk of dampness:

Sample house condition surveys – to measure and monitor the effect of dampness (and housing conditions generally)

Guidance for home owners/landlords on identifying and rectifying damp/mould.

Consider grants to improve homes of those who cannot afford work Building regulations should prevent dampness and the proliferation

of indoor allergens in new homes Education for households on the risks of living in damp/mouldy

homes and reducing humidity/condensation. Money spent on prevention will save lives/money