A simulation model of building intervention impacts on indoor environmental quality, pediatric asthma, and costs
A simulation model of building intervention impacts on indoor environmental quality, pediatric asthma, and costs
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DOI：
10.1016/j.jaci.2013.06.003
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发表时间：
2014-01-01
影响因子：
14.2
通讯作者：
Levy, Jonathan Ian
中科院分区：
文献类型：
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作者：
Fabian, Maria Patricia;Adamkiewicz, Gary;Levy, Jonathan Ian
背景资料：虽然室内环境条件会影响儿童哮喘患者，但很少有研究表明建筑干预对哮喘相关结局的影响。模拟模型可以评估这种复杂的系统，但还没有应用在这方面的context.Objective：我们试图评估建筑干预对室内环境质量和儿科哮喘医疗保健使用的影响，并进行干预和医疗保健成本和节能之间的成本比较。方法：我们应用我们以前开发的离散事件模拟模型（DEM）来模拟环境因素，服药依从性，季节性，和病史对（1）室内污染物浓度和（2）低收入多户住宅哮喘的影响。我们估计医疗保健的使用和成本在基线和随后的干预措施，然后比较医疗保健成本与节能和干预costs.Results：干预措施，如综合虫害管理和维修厨房排气扇，导致7%至12%的严重哮喘事件减少1至3年的投资回收期。仅针对收紧建筑物外壳的风化措施导致20%以上的严重哮喘事件，但与修理厨房排气扇和消除室内污染源捆绑在一起（例如，煤气炉或吸烟者）减轻了这种影响。我们的儿科哮喘模型提供了一种工具，可以根据对健康和成本的影响，优先考虑单独和捆绑的建筑干预措施，突出了风化，室内空气质量和健康。我们的工作弥合了临床和环境健康科学之间的差距，增加了医生对家庭环境变化对患者哮喘的影响的理解。
Background: Although indoor environmental conditions can affect pediatric asthmatic patients, few studies have characterized the effect of building interventions on asthma-related outcomes. Simulation models can evaluate such complex systems but have not been applied in this context.Objective: We sought to evaluate the impact of building interventions on indoor environmental quality and pediatric asthma health care use, and to conduct cost comparisons between intervention and health care costs and energy savings.Methods: We applied our previously developed discrete event simulation model (DEM) to simulate the effect of environmental factors, medication compliance, seasonality, and medical history on (1) pollutant concentrations indoors and (2) asthma outcomes in low-income multifamily housing. We estimated health care use and costs at baseline and subsequent to interventions, and then compared health care costs with energy savings and intervention costs.Results: Interventions, such as integrated pest management and repairing kitchen exhaust fans, led to 7% to 12% reductions in serious asthma events with 1- to 3-year payback periods. Weatherization efforts targeted solely toward tightening a building envelope led to 20% more serious asthma events, but bundling with repairing kitchen exhaust fans and eliminating indoor sources (eg, gas stoves or smokers) mitigated this effect.Conclusion: Our pediatric asthma model provides a tool to prioritize individual and bundled building interventions based on their effects on health and costs, highlighting the tradeoffs between weatherization, indoor air quality, and health. Our work bridges the gap between clinical and environmental health sciences by increasing physicians' understanding of the effect that home environmental changes can have on their patients' asthma.