{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,18]],"date-time":"2025-12-18T14:20:35Z","timestamp":1766067635907,"version":"build-2065373602"},"reference-count":59,"publisher":"MDPI AG","issue":"21","license":[{"start":{"date-parts":[[2022,11,3]],"date-time":"2022-11-03T00:00:00Z","timestamp":1667433600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Funda\u00e7\u00e3o para a Ci\u00eancia e Tecnologia\u2014within MIT SES Portugal Doctoral Program","award":["PD\/BD\/128029\/2016","UIDB\/00319\/2020"],"award-info":[{"award-number":["PD\/BD\/128029\/2016","UIDB\/00319\/2020"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Sustainability"],"abstract":"<jats:p>Housing quality is a well-established determinant for health and its relevance has been increasing in the context of sustainable development. Prior research has emphasized the importance of adequate housing for the health and comfort of householders. However, this link is still poorly characterized and understood regarding the vulnerable segments of the population. In this study, a mediation analysis is proposed to test and identify the role of energy affordability in the relationship between poor housing and health status. It resorts to microdata from the European Union\u2014Statistics on Income and Living Conditions (EU-SILC) database, focusing on the analysis of Portugal as the case study. Research findings confirm the role of energy affordability as a mediator. The research findings supported the energy efficiency as a direct pathway with protective and preventive effect for poor health, followed by energy affordability as a mediated or indirect pathway. A complementary approach that addresses energy efficiency and energy poverty should be pursued to maximize health risk reduction.<\/jats:p>","DOI":"10.3390\/su142114435","type":"journal-article","created":{"date-parts":[[2022,11,4]],"date-time":"2022-11-04T04:00:51Z","timestamp":1667534451000},"page":"14435","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["The Role of Energy Affordability in the Relationship between Poor Housing and Health Status"],"prefix":"10.3390","volume":"14","author":[{"given":"F\u00e1tima","family":"Lima","sequence":"first","affiliation":[{"name":"Faculty of Engineering (FEUP), University of Porto, 4200-026 Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3712-4803","authenticated-orcid":false,"given":"Paula","family":"Ferreira","sequence":"additional","affiliation":[{"name":"ALGORITMI Research Centre, School of Engineering Campus de Azur\u00e9m, University of Minho, 4800-058 Guimar\u00e3es, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8396-2907","authenticated-orcid":false,"given":"V\u00edtor","family":"Leal","sequence":"additional","affiliation":[{"name":"Department of Mechanical Engineering, Faculty of Engineering (FEUP), Institute of Science and Innovation in Mechanical Engineering and Management Engineering (INEGI), University of Porto, 4200-465 Porto, Portugal"}]}],"member":"1968","published-online":{"date-parts":[[2022,11,3]]},"reference":[{"key":"ref_1","unstructured":"VELUX Group (2018). Healthy Homes Barometer 2018: (Un)Healthy Homes, Offices, and Suburbanisation in Europe, VELUX."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1177\/0969776415596449","article-title":"The energy divide: Integrating energy transitions, regional inequalities and poverty trends in the European Union","volume":"24","author":"Bouzarovski","year":"2017","journal-title":"Eur. Urban Reg. Stud."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"360","DOI":"10.1177\/0969776417720250","article-title":"Illuminating austerity: Lighting poverty as an agent and signifier of the Greek crisis","volume":"25","author":"Petrova","year":"2017","journal-title":"Eur. Urban Reg. Stud."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Ulucak, R., Sari, R., Erdogan, S., and Castanho, R.A. (2021). Bibliometric Literature Analysis of a Multi-Dimensional Sustainable Development Issue: Energy Poverty. Sustainability, 13.","DOI":"10.3390\/su13179780"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Al-Tal, R., Murshed, M., Ahmad, P., Alfar, A.J.K., Bassim, M., Elheddad, M., Nurmakhanova, M., and Mahmood, H. (2021). The Non-Linear Effects of Energy Efficiency Gains on the Incidence of Energy Poverty. Sustainability, 13.","DOI":"10.3390\/su131911055"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"113181","DOI":"10.1016\/j.enpol.2022.113181","article-title":"Energy poverty and emerging debates: Beyond the traditional triangle of energy poverty drivers","volume":"169","author":"Stojilovska","year":"2022","journal-title":"Energy Policy"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1016\/j.enbuild.2016.03.064","article-title":"Predicting and characterizing indoor temperatures in residential buildings: Results from a monitoring campaign in Northern Portugal","volume":"119","author":"Leal","year":"2016","journal-title":"Energy Build."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1016\/j.egypro.2016.12.112","article-title":"Mapping Fuel Poverty in Portugal","volume":"106","author":"Simoes","year":"2016","journal-title":"Energy Procedia"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1016\/j.scs.2017.12.016","article-title":"Indoor hygrothermal conditions and quality of life in social housing: A comparison between two neighbourhoods","volume":"38","author":"Ramos","year":"2018","journal-title":"Sustain. Cities Soc."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"109423","DOI":"10.1016\/j.enbuild.2019.109423","article-title":"Energy poverty in Portugal: Combining vulnerability mapping with household interviews","volume":"203","author":"Horta","year":"2019","journal-title":"Energy Build."},{"key":"ref_11","unstructured":"Energy Poverty Advisory Hub (EPAH) (2022). Introduction to the Energy Poverty Advisory Hub (EPAH) Handbooks: A Guide to Understanding and Addressing Energy Poverty, Energy Poverty Advisory Hub (EPAH)."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"749","DOI":"10.1097\/EDE.0000000000000121","article-title":"A unification of mediation and interaction: A four-way decomposition","volume":"25","author":"Vanderweele","year":"2015","journal-title":"Epidemiology"},{"key":"ref_13","unstructured":"European Commission (2015). Methodological Guidelines And Description Of Eu-Silc Target Variables 2015 Operation, European Commission. version 2014."},{"key":"ref_14","unstructured":"(2021, May 06). Eu-Silc Ad-Hoc Modules. AD-HOC MODULES. Available online: https:\/\/ec.europa.eu\/eurostat\/web\/income-and-living-conditions\/data\/ad-hoc-modules."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1016\/j.enbuild.2013.06.024","article-title":"Financial crisis and energy consumption: A household survey in Greece","volume":"65","author":"Santamouris","year":"2013","journal-title":"Energy Build."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1016\/j.ypmed.2017.09.020","article-title":"The impact of persistent poor housing conditions on mental health: A longitudinal population-based study","volume":"105","author":"Pevalin","year":"2017","journal-title":"Prev. Med."},{"key":"ref_17","first-page":"19","article-title":"Study shows that unhealthy homes lead to reduced health","volume":"3","author":"John","year":"2018","journal-title":"REHVA J."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"107067","DOI":"10.1016\/j.buildenv.2020.107067","article-title":"Association of residential energy efficiency retrofits with indoor environmental quality, comfort, and health: A review of empirical data","volume":"180","author":"Fisk","year":"2020","journal-title":"Build. Environ."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1016\/j.enpol.2011.09.003","article-title":"Health and thermal comfort: From WHO guidance to housing strategies","volume":"49","author":"Ormandy","year":"2011","journal-title":"Energy Policy"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"649","DOI":"10.1080\/02673030500114656","article-title":"Keeping Warm and Staying Well Does Home Energy Efficiency Mediate the Relationship between Socio-economic Status and the Risk of Poorer Health?","volume":"20","author":"Heyman","year":"2005","journal-title":"Hous. Stud."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"382","DOI":"10.1016\/j.enpol.2017.04.011","article-title":"\u201cDamp in bathroom. Damp in back room. It\u2019s very depressing!\u201d exploring the relationship between perceived housing problems, energy affordability concerns, and health and well-being in UK social housing","volume":"106","author":"Boomsma","year":"2017","journal-title":"Energy Policy"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1016\/j.buildenv.2018.06.028","article-title":"Effects of neighborhood building density, height, greenspace, and cleanliness on indoor environment and health of building occupants","volume":"145","author":"Chan","year":"2018","journal-title":"Build. Environ."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"106443","DOI":"10.1016\/j.ypmed.2021.106443","article-title":"Exploring neighborhood socioeconomic disparity in self-rated health: A multiple mediation analysis","volume":"145","author":"Rodrigues","year":"2021","journal-title":"Prev. Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"110954","DOI":"10.1016\/j.enpol.2019.110954","article-title":"Winter thermal comfort and health in the elderly","volume":"134","author":"Hughes","year":"2019","journal-title":"Energy Policy"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1093\/ije\/dyy236","article-title":"Med4way: A Stata command to investigate mediating and interactive mechanisms using the four-way effect decomposition","volume":"48","author":"Discacciati","year":"2019","journal-title":"Int. J. Epidemiol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1169","DOI":"10.1093\/ije\/dyy069","article-title":"Growth parameters at birth mediate the relationship between prenatal manganese exposure and cognitive test scores among a cohort of 2- to 3-year-old Bangladeshi children","volume":"47","author":"Lee","year":"2018","journal-title":"Int. J. Epidemiol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"100009","DOI":"10.1016\/j.gloepi.2019.100009","article-title":"Decomposing the effects of physical activity and cardiorespiratory fitness on mortality","volume":"1","author":"Wolfson","year":"2019","journal-title":"Glob. Epidemiol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"538","DOI":"10.1016\/j.jad.2019.11.088","article-title":"Prospective relationships of mentally passive sedentary behaviors with depression: Mediation by sleep problems","volume":"265","author":"Hallgren","year":"2020","journal-title":"J. Affect. Disord."},{"key":"ref_29","unstructured":"Eurostat (2021, May 06). EU-SILC Overview 2021. Available online: https:\/\/ec.europa.eu\/eurostat\/web\/income-and-living-conditions."},{"key":"ref_30","unstructured":"Instituto Nacional de Estat\u00edstica (2017). Inqu\u00e9rito \u00e0s Despesas das Fam\u00edlias 2015\/2016."},{"key":"ref_31","unstructured":"European Commission Eurostat (2015). Household Budget Survey: 2010 Wave EU Quality Report, European Commission Eurostat."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"104592","DOI":"10.1016\/j.eneco.2019.104592","article-title":"An economic approach to the study of the relationship between housing hazards and health: The case of residential fuel poverty in France","volume":"85","author":"Kahouli","year":"2019","journal-title":"Energy Econ."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"137146","DOI":"10.1016\/j.scitotenv.2020.137146","article-title":"Healthy buildings for a healthy city: Is the public health evidence base informing current building policies?","volume":"719","author":"Carmichael","year":"2020","journal-title":"Sci. Total Environ."},{"key":"ref_34","unstructured":"Eurostat (2021, July 06). Self-Perceived Health: Statistics Explained. Available online: https:\/\/ec.europa.eu\/eurostat\/statistics-explained\/index.php?title=Glossary:Self-perceived_health."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"495","DOI":"10.1111\/roiw.12341","article-title":"Housing and Health","volume":"65","author":"Angel","year":"2017","journal-title":"Rev. Income Wealth"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"105990","DOI":"10.1016\/j.ypmed.2020.105990","article-title":"\u2018Home is where the health is\u2019: Housing quality and adult health outcomes in the Survey of Income and Program Participation","volume":"132","author":"Boch","year":"2020","journal-title":"Prev. Med."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1283","DOI":"10.1093\/ageing\/afaa277","article-title":"Social gradient of self-rated health in older people\u2014the moderating\/mediating role of sense of community","volume":"50","author":"Lai","year":"2021","journal-title":"Age Ageing"},{"key":"ref_38","unstructured":"Eurostat (2021, May 06). EU-SILC: Data-Information on Data. Available online: https:\/\/ec.europa.eu\/eurostat\/web\/income-and-living-conditions\/data."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"428","DOI":"10.1016\/j.enbuild.2018.05.022","article-title":"The relationship between poverty and indoor temperatures in winter: Determinants of cold homes in social housing contexts from the 40s\u201380s in Northern Spain","volume":"173","year":"2018","journal-title":"Energy Build."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3310\/phr06050","article-title":"The health impacts of energy performance investments in low-income areas: A mixed-methods approach","volume":"6","author":"Poortinga","year":"2018","journal-title":"Public Health Res."},{"key":"ref_41","unstructured":"Eurostat (2021, June 06). Equivalised Disposable Income: Statistics Explained. Available online: https:\/\/ec.europa.eu\/eurostat\/statistics-explained\/index.php?title=Glossary:Equivalised_disposable_income."},{"key":"ref_42","unstructured":"Eurostat (2021, June 06). Income Quintile Group: Statistics Explained. Available online: https:\/\/ec.europa.eu\/eurostat\/statistics-explained\/index.php?title=Glossary:Income_quintile_group."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1016\/j.enpol.2016.11.050","article-title":"Energy efficiency of housing for older citizens: Does it matter?","volume":"101","author":"Miller","year":"2017","journal-title":"Energy Policy"},{"key":"ref_44","unstructured":"Arigoni, D. (2018). Preparing for an Aging Population: Factsheet, WHO Regional Office for the Western Pacific."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1016\/j.envint.2015.09.010","article-title":"Impact of climate change on the domestic indoor environment and associated health risks in the UK","volume":"85","author":"Vardoulakis","year":"2015","journal-title":"Environ. Int."},{"key":"ref_46","unstructured":"Eurostat (2021, May 06). EU-SILC: Metadata. Available online: https:\/\/ec.europa.eu\/eurostat\/cache\/metadata\/en\/ilc_esms.htm."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1146\/annurev-publhealth-032315-021402","article-title":"Mediation Analysis: A Practitioner\u2019s Guide","volume":"37","author":"VanderWeele","year":"2016","journal-title":"Annu. Rev. Public Health"},{"key":"ref_48","unstructured":"SAS Institute Inc. (2017). SAS\/STAT\u00ae 14.3 User\u2019s Guide The CAUSALMED Procedure, SAS Institute."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"7477","DOI":"10.1002\/cam4.3418","article-title":"A mediation analysis to explain socio-economic differences in bladder cancer survival","volume":"9","author":"Russell","year":"2020","journal-title":"Cancer Med."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1016\/j.annepidem.2018.10.007","article-title":"Poor peer relations in adolescence, social support in early adulthood, and depressive symptoms in later adulthood\u2014evaluating mediation and interaction using four-way decomposition analysis","volume":"29","author":"Bean","year":"2019","journal-title":"Ann. Epidemiol."},{"key":"ref_51","unstructured":"WHO (2021, July 06). NCDs and Ageing, Available online: https:\/\/www.who.int\/westernpacific\/about\/governance\/regional-director\/ncds-and-ageing."},{"key":"ref_52","unstructured":"WHO (2021, October 05). World Health Organization\u2014Noncommunicable Diseases (NCD) Country Profiles: Portugal, Available online: https:\/\/www.who.int\/nmh\/countries\/2018\/prt_en.pdf?ua=1."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"246","DOI":"10.1016\/j.enbuild.2019.03.002","article-title":"Mapping the energy performance gap of dwelling stock at high-resolution scale: Implications for thermal comfort in Portuguese households","volume":"190","author":"Palma","year":"2019","journal-title":"Energy Build."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"909","DOI":"10.1016\/j.egypro.2017.09.717","article-title":"A complementary approach for energy efficiency and comfort evaluation of renovated dwellings in Southern Europe","volume":"132","year":"2017","journal-title":"Energy Procedia"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"534","DOI":"10.1016\/j.jclepro.2018.01.021","article-title":"Mining households\u2019 energy data to disclose fuel poverty: Lessons for Southern Europe","volume":"178","author":"Gouveia","year":"2018","journal-title":"J. Clean. Prod."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1177\/09697764211043424","article-title":"Beyond renovation: Addressing Europe\u2019s long housing crisis in the wake of the COVID-19 pandemic","volume":"28","author":"Vidal","year":"2021","journal-title":"Eur. Urban Reg. Stud."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1177\/0969776418787222","article-title":"Urban living laboratories: Conducting the experimental city?","volume":"26","author":"Bulkeley","year":"2018","journal-title":"Eur. Urban Reg. Stud."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"111687","DOI":"10.1016\/j.enbuild.2021.111687","article-title":"Bridging the energy performance gap of social housing stock in south-eastern Mediterranean Europe: Climate change and mitigation","volume":"258","author":"Ozarisoy","year":"2021","journal-title":"Energy Build."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"440","DOI":"10.1016\/j.buildenv.2015.05.019","article-title":"Climate change and thermal comfort in Southern Europe housing: A case study from Lisbon","volume":"92","author":"Barbosa","year":"2015","journal-title":"Build. Environ."}],"container-title":["Sustainability"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2071-1050\/14\/21\/14435\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:10:07Z","timestamp":1760145007000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2071-1050\/14\/21\/14435"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,11,3]]},"references-count":59,"journal-issue":{"issue":"21","published-online":{"date-parts":[[2022,11]]}},"alternative-id":["su142114435"],"URL":"https:\/\/doi.org\/10.3390\/su142114435","relation":{},"ISSN":["2071-1050"],"issn-type":[{"type":"electronic","value":"2071-1050"}],"subject":[],"published":{"date-parts":[[2022,11,3]]}}}