Eligibility criteria for the UK Winter Fuel Payment: are we targeting the right people?

Background Cold weather remains a serious health threat in the UK and elsewhere, particularly for older adults. The Winter Fuel Payment has been a key government strategy to mitigate health risks linked to cold homes in the UK, but recent policy shifts have raised questions about whether income-based eligibility criteria effectively identify those most at risk.Methods We analysed cold-related mortality in adults aged ≥75 across 324 local authority districts in England (2007-2019) using distributed lag non-linear models in a spatial Bayesian framework. Multivariate meta-regression was used to evaluate modification of cold effects by deprivation, income-based pension credit uptake, home energy efficiency and fuel poverty.Results Areas in the highest quartile of fuel poverty had significantly greater cold-related mortality risk than those in the lowest quartile, with a 15.3% versus 13.1% increase in mortality risk at the first compared with the 50th percentile of wintertime temperature, ie, an absolute difference of 2.2% (p