Prepayment meters strongly associated with economic and health deprivation: an observational, cross-sectional study

Objectives: To examine to what extent pre-payment meters (PPMs) are associated with multiple measures of structural economic and health deprivation. Design: Cross-sectional, observational. Setting: England and Wales. Data source: Experimental Lower Layer Super Output Area (LSOA) prepayment electricity meter consumption 2017 is used to map the percentage of PPMs for each LSOA. Number of domestic prepayment meters and meters for 33,332 LSOA regions across England and Wales are linked with multiple sub-national LSOA deprivation and health measures. Smart meters operating in prepayment mode are not included. Outcome measures: Prevalence of PPMs for electricity bills per LSOA, associated with multiple national deprivation measures. In England: fuel poverty; income deprivation children and older people; living environment; barriers to housing and services; crime; health and disability; education, skills and training; employment; income; overall Index of Multiple Deprivation (IMD). In Wales: physical environment; community safety; housing; access to services; education; health; employment; income; overall Welsh Index of Multiple Deprivation (WIMD). Additional outcomes of Tenure Type of Housing (rented social, private; owned) and emergency hospital admissions for chronic obstructive pulmonary disease (England) and all respiratory diseases (Wales). Results: PPM prevalence is strongly correlated (0.62 to 0.63) with fuel poverty, with similar patterns in England and Wales. In England, PPM prevalence was strongly associated with virtually all deprivation indicators, including: lower income (-0.83 [-0.83 to -0.82]), receipt of employment-related benefits (-0.76 [-0.77 to -0.76]), educational disadvantage (-0.70 [-0.70 to -0.69]) and higher levels of health deprivation (-0.65 [-0.65 to -0.63]). Higher PPM prevalence is concentrated in low-income families with children and older individuals, strongly associated with income deprivation affecting children (-0.8 [-0.81 to -0.80]) and older people (-0.79 [-0.80 to -0.79]), social rent (0.67 [0.66 to 0.68]), hospital admissions for respiratory diseases (England 0.69 [0.68 to 0.70]; Wales 0.64 [0.58 to 0.70]), indicating a heightened risk of illness. Conclusions: Instead of blanket policies, interventions on households with PPMs offers an immediate solution to avoid a health crisis and shield vulnerable households from a "heat or eat" dilemma and further exacerbating existing inequalities.