Preval Nicholas, Keall Michael, Telfar-Barnard Lucy, Grimes Arthur, Howden-Chapman Philippa
Public Health Department, University of Otago, Wellington, New Zealand.
School of Government, Victoria University of Wellington, Wellington, New Zealand.
BMJ Open. 2017 Nov 14;7(11):e018079. doi: 10.1136/bmjopen-2017-018079.
We carried out an evaluation of a large-scale New Zealand retrofit programme using administrative data that provided the statistical power to assess the effect of insulation and/or heating retrofits on cardiovascular and respiratory-related mortality in people aged 65 and over with prior respiratory or circulatory hospitalisations.
Quasi-experimental cohort study based on administrative data.
New Zealand.
From a larger study cohort of over 900 000 people, we selected two subcohorts: 3287 people who were aged 65 and over and had experienced pretreatment period cardiovascular-related hospitalisation (ICD-10 chapter 9), and 1561 people aged 65 and over who had experienced pretreatment respiratory-related hospitalisation (ICD-10 chapter 10).
Treatment group individuals lived in a home that received insulation and/or heating retrofits under the Warm Up New Zealand: Heat Smart programme. Control group individuals lived in a home that was matched to a treatment home based on physical characteristics and location.
HR for all-cause mortality for treatment with insulation, heating, or insulation and heating relative to control group.
People with pretreatment circulatory hospitalisation who occupied a household that received only insulation had an HR for all-cause mortality of 0.673 (95% CI 0.535 to 0.847) (p<0.001) relative to control group members. Individuals with a pretreatment respiratory hospitalisation who occupied a household that received only an insulation retrofit had an HR for all-cause mortality of 0.830 (95% CI 0.655 to 1.051) (p=0.122) relative to control group members. There was no evidence of an additional benefit from receiving heating.
We interpret the hazard rate observed for cardiovascular subcohort individuals who received insulation as evidence of a protective effect, reducing the risk of mortality for vulnerable older adults. There is suggestive evidence of a protective effect of insulation for the respiratory subcohort.
我们利用行政数据对新西兰一项大规模的房屋改造计划进行了评估，这些数据提供了统计效力，以评估隔热和/或供暖改造对65岁及以上曾有呼吸或循环系统住院史人群心血管和呼吸相关死亡率的影响。
基于行政数据的准实验队列研究。
新西兰。
从一个超过90万人的更大研究队列中，我们选取了两个亚组：3287名65岁及以上且在预处理期有心血管相关住院史（国际疾病分类第十版第9章）的人，以及1561名65岁及以上有预处理期呼吸相关住院史（国际疾病分类第十版第10章）的人。
治疗组个体居住在根据“新西兰暖屋：明智取暖”计划进行了隔热和/或供暖改造的房屋中。对照组个体居住在根据物理特征和位置与治疗组房屋匹配的房屋中。
隔热、供暖或隔热加供暖治疗相对于对照组的全因死亡率的风险比。
与对照组成员相比，仅接受隔热改造的房屋中曾有循环系统住院史的人全因死亡率的风险比为0.673（95%置信区间0.535至0.847）（p<0.001）。与对照组成员相比，仅接受隔热改造的房屋中曾有呼吸相关住院史的人全因死亡率的风险比为0.830（95%置信区间0.655至1.051）（p = 0.122）。没有证据表明供暖有额外益处。
我们将接受隔热改造的心血管亚组个体观察到的危险率解释为具有保护作用的证据，即降低了脆弱老年人的死亡风险。有提示性证据表明隔热对呼吸亚组有保护作用。
