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Observational Study
. 2023 Dec 8;78(1):54-60.
doi: 10.1136/jech-2023-220793.

Prepayment meters strongly associated with multiple types of deprivation and emergency respiratory hospital admissions: an observational, cross-sectional study

Xuejie Ding  1   2 , Evelina T Akimova  3 , Bo Zhao  3 , Kasimir Dederichs  3   4 , Melinda C Mills  1   5   6
Affiliations
Observational Study

Prepayment meters strongly associated with multiple types of deprivation and emergency respiratory hospital admissions: an observational, cross-sectional study

Xuejie Ding et al. J Epidemiol Community Health. .

Erratum in

Abstract

Background: Prepayment meters (PPMs) require energy to be paid in advance. Action groups and media contend that PPMs are concentrated in the most vulnerable groups, prone to run out of credit and experience financial burden. This led to forced installation for those over age 85 being banned in April 2023 and a 'prepayment premium' scrapped in July 2023. Yet, we lack empirical evidence of which groups PPMs are concentrated. This ecological study examines the extent to which PPMs are associated with multiple measures of structural social, economic and health deprivation to establish evidence-based policy.

Methods: Combining multiple regional data and census estimates at the Lower Layer Super Output Area and the Middle Layer Super Output Area level from England and Wales, we use Spearman's rank correlation, Pearson correlation and multivariate linear regression to empirically establish associations between PPMs and multiple types of deprivation.

Results: Higher PPM prevalence is strongly associated with: lower income, receipt of employment benefits, ethnic minorities, lower education and higher health deprivation. Higher PPM prevalence is strongly associated with higher income deprivation affecting children, the elderly and social rental properties. PPMs are significantly associated with emergency hospital admissions for respiratory diseases in England, even after controlling for confounders (coefficient=1.81; 95% CI 1.51 to 2.11).

Conclusions: We found empirical evidence that PPM users are concentrated among the population who already experience multiple disadvantages. Furthermore, PPM concentrated areas are associated with higher emergency hospital admissions for respiratory diseases.

Keywords: deprivation; health inequalities; policy; public health; social sciences.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Subnational (Lower Layer Super Output Area) percentages of prepayment electricity meters. England and Wales. PPM, prepayment meter.
Figure 2
Figure 2
Correlation between prepayment electricity meters prevalence and multiple deprivation indices. England (A) and Wales (B). The navy bar shows the Spearman correlation coefficients between PPM and each deprivation indices (except for Fuel poverty and PPMs, which is Pearson correlation). The yellow bar shows the Spearman correlation coefficients between fuel poverty and each deprivation index. All coefficients are statistically significant expect for environment in (B). IDACI, Income Deprivation Affecting Children Index; IDAOPI, Income Deprivation Affecting Older People Index; IMD, Index of Multiple Deprivation; PPM, prepayment meter.
Figure 3
Figure 3
Prepayment electricity meters prevalence (Lower Layer Super Output Area) and tenure types, house building year and multiglazing windows in England and Wales. EPC D above, Energy Performance Certificate of D rating or higher; PPM, prepayment meter.
Figure 4
Figure 4
Theory of change on prepayment meter prevalence and its association with deprivation.
See this image and copyright information in PMC

References

    1. Citizens Advice . Millions left in the cold and dark as someone on a prepayment meter cut off every 10 seconds, reveals citizens advice. 2023. Available: https://www.citizensadvice.org.uk/about-us/about-us1/media/press-release... [Accessed 25 Apr 2023].
    1. Sky News . Forced installation of prepayment energy meters banned for over 85S under new Ofgem code of practice. 2023. Available: https://news.sky.com/story/forced-installation-of-prepayment-meters-bann...
    1. GOV.UK . Prepayment meter customers to pay less for energy from today. 2023. Available: https://www.gov.uk/government/news/prepayment-meter-customers-to-pay-les... [Accessed 6 Jul 2023].
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