Prevalence, Risk Factors and Impacts Related to Mould-Affected Housing: An Australian Integrative Review
Abstract
:1. Introduction
- A recent government inquiry into biotoxin-related illness reported impacts on health and economic well-being of occupants living in mould-affected housing [41].
2. Materials and Methods
2.1. Literature Review Methodology
What is the current state of evidence on the prevalence, risk factors and impacts related to mould-affected housing in Australia?
2.2. Inclusion/Exclusion Criteria and Quality Appraisal
2.3. Data Management and Extraction
3. Results
3.1. Profile of Included Literature
3.2. Study Topics Included in the Literature
3.3. Chronological Distribution of Included Literature
- The cessation of mould reporting by the Australian Bureau of Statistics.
- The investigation of indoor air quality in housing and biological data in relationship to health was mainly undertaken in the mid-1990s;
- There are three times more studies exploring socioeconomic factors/circumstance relating to housing conditions than that of epidemiological, clinical and health studies since 2007;
- As building regulations moved towards more energy efficient housing and bushfire housing safety requirements, building sciences, architecture, property, law and the building/mould industry start investigating interventions, defects and “root cause” of moisture-related building issues in built environment;
- There is a 22-year gap in capturing or reporting indoor mould in population-based housing studies. This may indicate an incorrect assumption, until relatively recently, that enhancements in building regulations had “fixed the problem” of mould in houses (and hence the perceived lack of need to collect this data). Alternatively, it may be an indication of the consequences of the funding restrictions placed on the data collection agency (and hence the inability to collect all of the data about housing that was previously funded).
3.4. Geographical Location of Included Literature
4. Discussion
4.1. Climate and Risk of Indoor Mould
- Houses have subfloor ventilation and naturally ventilated roof spaces;
- The opening of windows to cool a home is common on warmer days;
- Residential buildings are not fully sealed or fully mechanically cooled or ventilated.
4.2. Housing Conditions and Risk of Indoor Mould
- The question does not allow for the variable “mould” in the answer?
- The variable is not statistically significant enough to be reported upon.
4.2.1. Housing Conditions, Rental Housing and Risk of Mould
4.2.2. Housing Conditions, COVID-19 Insights and Risk of Mould
4.3. Housing Conditions, Socioeconomic Circumstance and Risk of Mould
4.4. Building Characteristics and Risk of Mould
4.5. Occupant Behaviours and Risk of Mould
4.6. Prevalence of Indoor Mould Conditions in Australian Housing
4.7. Health Impacts Related to Reported Mould/Mildew/Fungi
4.8. Gaps and Implications for Research, Practice and Policy
- Implement national and climatical coverage of real-time data (temperature, available moisture, humidity) and “root cause” case study investigations for indoor mould in both older housing and code-compliant homes.
- Investigate the relationship between occupant behaviours, housing maintenance and the occurrence of indoor mould in poor-quality housing.
- Establish a national longitudinal housing condition survey that includes indoor mould, renovations and maintenance.
- To continue to use the question “Does this dwelling have any MAJOR building problems?” or similar in current longitudinal housing studies and report on the “mould” variable.
- Investigate the impact and characteristics of multiple-symptom health effects and their relationship to the biological components that are present in damp housing conditions.
“The precautionary principle, proposed as a new guideline in environmental decision making, has four central components: taking preventive action in the face of uncertainty; shifting the burden of proof to the proponents of an activity; exploring a wide range of alternatives to possibly harmful actions; and increasing public participation in decision making.”[125]
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Acknowledgments
Conflicts of Interest
References
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Policy websites | Australian Housing and Urban Research Institute (AHURI) | www.ahuri.edu.au/ (accessed on 8 November 2021). |
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Place | Mould | Housing | Risk/Impact |
---|---|---|---|
Australia | Mould | Hous *, House, Housing | Health |
Fungi | Indoor | Well-being, Well-being | |
Mildew | Home * | Cost * | |
Condensation | Dwelling * | Impact * | |
Flood * | Residen * | Hardship * | |
“Water damage” | Residential | Economic * | |
“Water damage” | Residence | Financial | |
Damp * | Building * | Risk * | |
Perception * |
Inclusion Criteria | Exclusion Criteria |
---|---|
Australian residential dwelling (detached and semi-detached single family homes, townhouses, units/apartments) | Houses or studies not based in Australia. Boarding houses or commercial buildings |
Occupants (all ages), expert opinions or housing data (including biological) | Building computer modelling studies |
Reports indoor mould/mildew/fungi | Does not report indoor mould/mildew/fungi |
Data/information quantitative, qualitative, case studies relating to prevalence, risk factors or impact and reported indoor mould/mildew/fungi | No data or unclear outcome relating to prevalence, risk factors or impact for reported indoor mould/mildew/fungi |
Any study design providing original data on housing conditions/occupants experiences or housing condition data from defects or insurance claims that are publicly available | Reviews and summaries based on secondary data |
Full text available | Full text not available |
Study Details | Study Categories | n (%) | Ref | |
---|---|---|---|---|
Geographical distribution | Australia-wide | 7 (15.6%) | [39,46,47,57,58,59,60] | |
Victoria (VIC) | 12 (26.7%) | [40,61,62,63,64,65,66,67,68,69,70,71] | ||
New South Wales (NSW) | 8 (17.7%) | [48,72,73,74,75,76,77,78] | ||
Tasmania (TAS) | 5 (11.1%) | [42,79,80,81,82] | ||
Western Australia (WA) | 4 (8.8%) | [83,84,85,86] | ||
South Australia (SA) | 2 (4.4%) | [87,88] | ||
Queensland (QLD) | 1 (2.2%) | [89] | ||
Australian Capital Territory (ACT) | ||||
Northern Territory (NT) | ||||
Combinations: (VIC, TAS, NSW, QLD, SA, WA) | 4 (8.8%) | [41,90,91,92] | ||
Unknown | 2 (4.4%) | [93,94] | ||
Quantitative Non-randomised Studies 18 (40%) | Cohort Studies | 8 (17.8%) | [48,62,63,64,77,79,80,89] | |
Cross-Sectional Studies | 7 (15.6%) | [66,67,68,69,74,81,83] | ||
Case Control (houses) | 2 (4.4%) | [85,86] | ||
Intervention Study (houses) | 1 (2.2%) | [84] | ||
Quantitative Descriptive Studies 18 (40%) | Prevalence Studies | 8 (17.8%) | [46,47,58,61,65,71,90,94] | |
Case Series (houses) | 3 (6.7%) | [42,73,82] | ||
Cohort Studies | 3 (6.7%) | [40,59,78] | ||
Cross-Sectional | 2 (4.4%) | [91,95] | ||
Case Report (human) | 1 (2.2%) | [93] | ||
Case Control (human) | 1 (2.2%) | [75] | ||
Mixed Methods Studies 5 (11.1%) | Mixed Methods Studies | 2 (4.4%) | [57,70] | |
Building Industry Reports | 3 (6.7%) | [39,72,92] | ||
Qualitative Descriptive Studies 4 (8.9%) | Qualitative Descriptive Studies | 3 (6.7%) | [76,87,88] | |
Government Inquiry Report | 1 (2.2%) | [41] | ||
Study quality appraisal | Authority, Accuracy, Coverage, Objectivity, Date, Significance Checklist (AACODS) n = 16 | n (%) | n (%) | Mixed Methods Assessment Tool (MMAT) n = 45 |
* | ||||
** | 1 (6.3%) | 2 (4.4%) | * | |
*** | 1 (2.2%) | ** | ||
**** | 6 (13.3%) | *** | ||
***** | 1 (6.3%) | 15 (33.3%) | **** | |
****** | 14 (87.5%) | 21 (46.7%) | ***** |
Study Topics | Number (n = 45) n (%) | Subtopics | Ref |
---|---|---|---|
Building characteristics | 19 (42.2%) | Indoor biological data | [66,67,68,69,74,81] |
Housing survey data | [60,91] | ||
Housing defects and “root cause” | [39,42,72,73,82,92] | ||
Indoor mould intervention | [70,71,84,85,86] | ||
Health | 14 (31.1%) | Asthma, allergy, respiratory | [40,62,63,64,79,80,89] |
Hypersensitivity pneumonitis | [93] | ||
Allergic alveolitis | [75] | ||
Other | [41,59,65,90,94] | ||
Housing conditions and socio-economic factors | 9 (20%) | Energy use and health | [78] |
Health | [76,77,87,88] | ||
Tenure | [47,48,58,61] | ||
COVID-19 insights and housing conditions | 2 (4.4%) | Mental health | [57] |
Renting | [46] | ||
Occupant behaviours | 1 (2.2%) | Hygiene practices and health | [83] |
Coverage of Climate Zones | Housing Conditions (n = 12) | Building Characteristics (n = 18) | ||
---|---|---|---|---|
n (%) | Ref | n (%) | Ref | |
All climate zones | 1 (5.6%) | [39] | ||
1—High humidity summer, warm winter | ||||
2—Warm humid summer, mild winter | ||||
3—Hot dry summer, warm winter | ||||
4—Hot dry summer, cool winter | ||||
5—Warm temperate | 1 (5.6%) | [75] | ||
5/6—Warm/mild temperate | 2 (16.7%) | [77,78] | 3 (16.7%) | [72,73,74] |
6—Mild temperate | 3 (25%) | [48,61,76] | 6 (33.3%) | [40,65,66,67,68,69] |
7—Cool temperate | 3 (16.7%) | [42,81,82] | ||
8—Alpine | ||||
Unspecified study locations | 7 (58.3%) | [46,47,57,58,87,88,91] | 4 (22.2%) | [41,60,90,92] |
Categories | Climate Zone | Risk Factors for Residential Indoor Mould/Mildew/Fungi | Level of Association |
---|---|---|---|
Indoor conditions | 5/6 | Hot walls compared to cooler room [73] | Y |
5/6 | Bedroom relative humidity levels RH > 80% [73] | Y | |
6 | High indoor humidity RH > 60% [40] | Y * | |
6 | RH equal > 70% [69] | Y * |
Categories | Data Before 2002 | Data After 2003 | Risk Factors for Residential Indoor Mould/Mildew/Fungi | Level of Association |
---|---|---|---|---|
Housing conditions | ||||
Housing conditions | x | Poor housing conditions [75] | Y * | |
x | Age of home >20 years (1992) [69], >10 years (1994) [60], >70 years (in 1991) [75] | Y *, Y, Y * | ||
x | x | Leaking roof/ceiling [60], water intrusion [40,69], leaks [73] | Y, Y *, PY | |
x | Water-damaged/collapsing wooden floorboards [75], cracks in cladding [40] | Y *, Y * | ||
Building characteristics—Building, design, construction | ||||
Construction | x | Exposing building materials to moisture during construction [41] | PY | |
x | Building defects (various water/moisture/waterproofing related) [41,72,92] | PY, Y | ||
Building envelope | x | Air-tightness in buildings, surface/interstitial condensation, thermal bridging, non-breathable wall wraps/foil wraps, unventilated walls [39,41,42,82,113,114,115] | PY, Y | |
x | Use of timber framing and/or gypsum board [41] | PY | ||
x | External walls adjoining unheated spaces [42,82,113,114,115] | Y | ||
Roof | x | Blocked gutters/incorrect gutter installation [41] | PY | |
Walls | x | Brick veneer [60] | Y | |
x | Double brick [60,67] | Y *, Y | ||
Foundation | x | Stumps [40] | Y * | |
Drainage | x | Inappropriate external drainage [73] | PY | |
Insulation | x | x | Limited or poorly installed insulation [49] | Y *, Y |
Building layout | x | Higher number of bedrooms or bathrooms [90] | Y | |
x | Airflow from bathrooms towards bedrooms [65,90] | Y | ||
x | Inadequate building orientation and lack of breezes [65,90] | Y | ||
Windows | x | Single glazed windows [70] | Y | |
x | Poorly ventilated areas behind curtains [70] | Y | ||
x | Lack of natural light [73] | PY | ||
x | Limited ventilation through open windows [40] | Y * | ||
Cooling/heating | x | Split-system air-conditioning units [41,84] | Y, PY | |
x | No solid fuel fire [67] | Y * | ||
x | Cold bedrooms [40] | Y * | ||
Ventilation/air flow | x | x | Inadequate ventilation [41,73,83,92] | PY, Y, Y * |
x | No bedroom ceiling fan, no kitchen exhaust fan, few extractor fans in wet areas [67] | Y * | ||
non-structural | x | Carpets without professional cleaning [85] | Y | |
x | Old carpets: 5 years or older [67] | Y * |
Categories | Data Before 2002 | Data After 2003 | Risk Factors for Residential Indoor Mould/Mildew/Fungi | Level of Association |
---|---|---|---|---|
Occupant behaviours | ||||
Ventilation | x | Windows left open [67] | Y * | |
x | Occupant unaware of their behaviours with condensation [39] | PY | ||
x | Occupant reluctant to open windows and doors due to energy costs [39] | PY | ||
x | Infrequent use of opening windows [40], infrequent natural ventilation [67] | Y * | ||
x | Lack of opening windows [40] | Y * | ||
Cleaning | x | Unclean plastic seals on a dishwasher doors [71] | Y * | |
x | Failure to remove indoor mould growth [40] | Y * | ||
x | Homes cleaned less [83], vacuuming > 1 week ago [67] | Y * | ||
Pets | x | Presence of 1 cat or presence of 1 dog [67] | Y * |
Symptom/Illness | Sufficient Evidence for an Association by World Health Organization (WHO) [1] | Association | (n = 45) |
---|---|---|---|
Asthma | Asthma in children [40] | Y * | 12 (26.7%) |
Asthma [65,90] | Qual | ||
Current asthma [79] | Y ** | ||
Greater odds for an asthma attack in the last 12 months [62] | Y * | ||
Increase in Peak Flow Variability (PFV) in asthmatics sensitised to fungi [63] | Y * | ||
Exacerbation of asthma [76] | Qual | ||
Wheeze | Wheeze [79] | Y ** | |
Increase in wheeze [62] | Y | ||
Cough | Cough [65,90] | Qual | |
Respiratory | Acute respiratory illness with cough (ARIwC) in children [89] | Y | |
Respiratory symptoms in children [40] | Y * | ||
Respiratory problems/conditions [76,87] | Qual | ||
Nocturnal chest tightness [79] | Y ** | ||
Increased bronchial hyperreactivity (BHR) [64] | Y * | ||
Clinical | Domestic allergic alveolitis [75] | Y * | |
Hypersensitivity pneumonitis [93] | Y | ||
Other symptom(s)/illness presentation | |||
Allergy | Allergy in children [40] | Y * | 7 (15.6%) |
Increase in allergy to fungi [62] | Y | ||
Protective—Lower risk of allergy to fungi [64] | Y | ||
Pollen and dust mite allergy [90] | Qual | ||
Atopy | Atopy in children [40] | Y * | |
Increase in atopy [62] | Y * | ||
Gastrointestinal | Gastrointestinal infections in children [77] | Y * | |
Mood/depression | Depression [57] | Y | |
Sadness/depression [87] | Qual | ||
Pain | Joint pain [87,90] | Qual | |
Multiple-symptom presentation | |||
Comorbidity | Biotoxin illness reported with multiple chemical sensitivity (MCS) [94] | Y | 5 (11.1%) |
Biotoxin illness reported with tick-borne illness [94] | Y | ||
ME/CFS | Moulds as a trigger for myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) [59] | Y | |
Biotoxin illness reported with ME/CFS [94] | Y | ||
Multiple-symptom presentation | Chronic fatigue, pain, memory and concentration problems, disorientation, insomnia, gastrointestinal issues, sinus issues, fever, headaches and respiratory issues [41] | Qual | |
Fatigue, bronchial complaints, hay fever, headaches, hyperactivity, hypersensitivity or allergy, mood change, sensitivity to foods, water and textiles, sinus complaints, loss of sense of smell, pollen and dust mite allergy, skin complaints (eczema, itching, inflammation) [65,90] | Qual |
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Coulburn, L.; Miller, W. Prevalence, Risk Factors and Impacts Related to Mould-Affected Housing: An Australian Integrative Review. Int. J. Environ. Res. Public Health 2022, 19, 1854. https://doi.org/10.3390/ijerph19031854
Coulburn L, Miller W. Prevalence, Risk Factors and Impacts Related to Mould-Affected Housing: An Australian Integrative Review. International Journal of Environmental Research and Public Health. 2022; 19(3):1854. https://doi.org/10.3390/ijerph19031854
Chicago/Turabian StyleCoulburn, Lisa, and Wendy Miller. 2022. "Prevalence, Risk Factors and Impacts Related to Mould-Affected Housing: An Australian Integrative Review" International Journal of Environmental Research and Public Health 19, no. 3: 1854. https://doi.org/10.3390/ijerph19031854