Viggers Helen Elizabeth, Ingham Tristram Richard, Chapman Ralph Brougham, Crane Julian, Currie Ann Beatrice, Davies Cheryl, Keall Michael, Howden-Chapman Philippa Lynne
Department of Public Health, University of Otago, Wellington, New Zealand.
Department of Medicine, University of Otago, Wellington, New Zealand.
Int J Chron Obstruct Pulmon Dis. 2025 Apr 16;20:1097-1109. doi: 10.2147/COPD.S483194. eCollection 2025.
PURPOSE: Aotearoa New Zealand (NZ) homes are cold by international standards, with many failing to achieve temperatures recommended by WHO housing and health guidelines. Despite strong evidence of seasonal exacerbations in Chronic Obstructive Pulmonary Disease (COPD), there has been little examination of the effect of household warmth, or housing quality on COPD outcomes. The Warm Homes for Elder New Zealanders (WHEZ) study aimed to see if subsidising electricity costs would improve the health outcomes of older people with COPD. Previous analysis showed a modest, typically 2-10% dependent on prior usage, increase in electricity use among the subsidised households. PATIENTS AND METHODS: Participants aged over 55 with doctor-diagnosed COPD were recruited from three regional centres, and where possible their dwelling was insulated after enrolment. A single-blinded randomised controlled trial of the effect of an electricity voucher (NZ$500) on health care usage during winter was carried out in three locations across New Zealand. The primary outcome was exacerbations treated with antibiotics, and/or corticosteroids. The Clinical Trial Registration is NCT01627418. Of the 520 participants assigned to a wave, partial or better data was achieved for 424; 215 of those were randomised to the early intervention group, and 209 to receive the intervention later. RESULTS: Despite the modest increase in energy use by study households, reported previously, there was no significant difference between study arms in the frequency of exacerbation of COPD (0.089, p=0.5875, 95% CI -1.406-1.584) nor hospitalisations. An exploratory analysis suggested a lower mortality among participants assigned to receive the intervention first (OR 0.310, p=0.0175, 95% CI 0.118-0.815). CONCLUSION: This study showed little effect of winter electricity vouchers on exacerbations of COPD. However, such vouchers increased energy use and may have reduced overall mortality. A larger study, particularly with susceptible subpopulations, is recommended to examine this mortality impact further.
目的：按照国际标准，新西兰的房屋偏冷，许多房屋的温度未达到世界卫生组织住房与健康指南所推荐的温度。尽管有确凿证据表明慢性阻塞性肺疾病（COPD）存在季节性加重情况，但对于家庭供暖或住房质量对COPD预后的影响，几乎没有相关研究。“新西兰老年人温暖家园”（WHEZ）研究旨在探讨补贴电费是否能改善老年COPD患者的健康预后。此前的分析表明，获得补贴的家庭用电量适度增加，通常增加2% - 10%，具体增幅取决于先前的用电量。 患者与方法：从三个地区中心招募年龄在55岁以上、经医生诊断患有COPD的参与者，在可能的情况下，其住所会在入组后进行隔热处理。在新西兰的三个地点开展了一项单盲随机对照试验，研究电费代金券（500新西兰元）对冬季医疗保健使用情况的影响。主要结局指标为使用抗生素和/或皮质类固醇治疗的病情加重情况。临床试验注册号为NCT01627418。在分配到某一波次的520名参与者中，424名获得了部分或更好的数据；其中215名被随机分配到早期干预组，209名稍后接受干预。 结果：尽管如先前报道，研究家庭的能源使用量有适度增加，但在COPD病情加重频率（0.089，p = 0.5875，95%CI -1.406 - 1.584）或住院率方面，各研究组之间没有显著差异。一项探索性分析表明，首先接受干预的参与者死亡率较低（OR 0.310，p = 0.0175，95%CI 0.118 - 0.815）。 结论：本研究表明冬季电费代金券对COPD病情加重几乎没有影响。然而，此类代金券增加了能源使用量，可能降低了总体死亡率。建议开展规模更大的研究，尤其是针对易感亚人群，以进一步研究这种对死亡率的影响。
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