The association of energy poverty with health, health care utilisation and medication use in southern Europe.

Energy poverty (EP) is defined as the inability of a household to secure a socially and materially required level of energy services in the home. The main objective of this study was to analyse the association between EP and distinct indicators of health status, health services utilisation and medication use in southern Europe, using the city of Barcelona as a case study. We conducted a cross-sectional study using the data of the Barcelona Health Survey for 2016 (n = 3519, 53.3% women). We calculated EP percentages according to age, country of birth and social class. We analysed the association between EP and 26 health-related indicators through prevalence ratios (PR), and quantified the impact of EP on health at the population level by calculating the percentage of population attributable risk (PAR%). In Barcelona, 13.3% of women and 11.3% of men experienced EP. The most frequently affected groups were people born in low- and middle-income countries, those from more disadvantaged social classes, and women aged 65 years and older. We found a strong association between EP and worse health status, as well as higher use of health services and medication. For example, compared with women without EP, those with EP reported poor mental health 1.9 (95% CI: 1.6-2.4) times more frequently. Compared with men without EP, those with EP reported poor mental health 2.1 (95% CI: 1.6-2.8) times more frequently. The combination of high EP prevalence and the strong association between EP and negative health outcomes resulted in high PAR%, indicating the striking impact of EP on health and health services at the population level. EP is an important public health problem in southern European urban contexts that should be included in policy priorities in order to address its structural causes and minimise its unfair and avoidable health effects.