Analysis of prevalence, awareness, treatment and disease burden of chronic obstructive pulmonary disease among three ethnics in rural Yunnan Province
LIU Lan and WANG Xu-ming contributed equally to this article
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摘要:
目的 分析云南省农村汉族、纳西族和白族慢性阻塞性肺疾病(chronic obstructive pulmonary disease, COPD)患病、知晓和治疗情况以及疾病负担现状。 方法 采用多阶段分层随机抽样方法抽取云南省3个县≥35岁的农村常住居民共7 534名进行现场问卷调查及肺功能检查。 结果 云南省汉族、纳西族和白族COPD患病率分别为11.51%、17.66%、13.23%，知晓率分别为11.11%、17.45%、45.92%，治疗率分别为10.42%、16.11%、45.02%，其中患病率以纳西族最高，汉族最低(P＜0.001);3个民族COPD的患病率男性均高于女性(均有P＜0.001)，且随年龄增大而升高(P＜0.001);白族COPD的知晓率和治疗率均远高于纳西族和汉族(均有P＜0.001);3个民族文化程度为初中及以上的COPD知晓率和治疗率均高于小学及以下人群(均有P＜0.001)。COPD每十万人口死亡率、每千人口早死导致的生命损失年(years of life lost, YLL)、伤残导致的生命损失年(years lived with disability, YLD)和伤残调整生命年(disability adjusted life year, DALY)，汉族居民分别为110.06/10万、9.75/1 000、44.62/1 000、54.37/1 000，纳西族为58.51/10万、17.25/1 000、68.68/1 000、85.93/1 000，白族为102.52/10万、8.22/1 000、51.22/1 000、59.44/1 000;3个民族男性COPD的死亡率和每千人口YLL、YLD、DALY值均高于女性(均有P＜0.001);纳西族COPD每千人口YLL、YLD和DALY值最高，汉族最低(均有P＜0.001)。 结论 云南省三个民族COPD的患病率和疾病负担均较高，且COPD的患病率、知晓率、治疗率和疾病负担均存在民族差异。应根据不同民族特征开展COPD的三级预防工作，降低COPD对人群健康的危害。 Abstract:Objective The aim of this study was to analyze the prevalence, awareness, treatment, and disease burden of chronic obstructive pulmonary disease (COPD) among Han majority, Naxi and Bai ethnic minorities in rural areas of Yunnan Province. Methods The multi-stage stratified random sampling method was used to select 7 534 rural residents aged ≥35 years from three counties in Yunnan Province. Each participant received questionnaire survey and pulmonary function examination. Results The prevalence rate of COPD among Han majority, Naxi and Bai ethnic minorities was 11.51%, 17.66% and 13.23%, awareness rate was 11.11%, 17.45% and 45.92%, and treatment rate was 10.42%, 16.11% and 45.02%, respectively. The highest prevalence of COPD was found in Naxi ethnic minority, whereas the lowest was found in Han majority (P < 0.001). Males had higher prevalence of COPD than females (P < 0.001), and prevalence of COPD increased with age for all three ethnics (P < 0.001). Among the three ethnics, persons with junior middle school educational level or above had higher awareness and treatment rate of COPD than those with primary school educational level or below. The mortality rate per 100 000 population, years of life lost (YLL) /1000 population, years lived with disability (YLD)/1 000 population and DALY/1 000 population (YLL) of COPD was 110.06, 9.75, 44.62 and 54.37 for Han people, 58.51, 17.25, 68.68 and 85.93 for Naxi minority people, and 102.52, 8.22, 51.22 and 59.44 for Bai minority people, respectively. The mortality rate per 100 000 population, YLL/1 000 population, YLD/1 000 population and DALY/1 000 population of COPD were higher in males than in females among the three ethnics. The highest YLL, YLD and DALY rates of COPD were found in Naxi ethnic minority, whereas the lowest was found in Han majority. Conclusion The findings indicate disease high prevalence and burden of COPD among the three ethnics and there are ethnic differences in prevalence, awareness, treatment, and burden of COPD in rural Yunnan Province. Ethnically tailed tertiary prevention measures of COPD are needed to reduce the harm of COPD to people's health in rural Yunnan Province. -
Key words:
- Chronic obstructive pulmonary disease /
- Prevalence /
- Awareness /
- Treatment /
- Burden of disease /
- Ethnic groups
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表 1 调查人群不同民族的基本人口学特征[n(%)]
Table 1. Demographic characteristics of different ethnics [n(%)]
特征变量 汉族 纳西族 白族 χ2值 P值 性别 6.674 0.036 男 1 216(48.60) 1 245(49.19) 1 145(45.78) 女 1 286(51.40) 1 286(50.81) 1 356(54.22) 年龄(岁) 141.770 ＜0.001 35~ < 45 270(10.79) 450(17.78) 292(11.68) 45~ < 55 590(23.58) 698(27.58) 591(23.63) 55~ < 65 590(23.58) 612(24.18) 584(23.35) 65~ < 75 700(27.98) 491(19.40) 595(23.79) ≥75 352(14.07) 280(11.06) 439(17.55) 文化程度 76.071 ＜0.001 小学及以下 1 701(67.99) 1 632(64.48) 1 410(56.38) 初中及以上 801(32.01) 899(35.52) 1 091(43.62) 医疗服务可及性(min) 580.533 ＜0.001 ≥30 727(29.06) 935(36.94) 212(8.48) ＜30 1 775(70.94) 1 596(63.06) 2 289(91.52) 家庭年人均收入(元) 10.125 0.006 ≤5 700 1 183(47.28) 1 310(51.76) 1 245(49.78) >5 700 1 319(52.72) 1 221(48.24) 1 256(50.22) 
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表 2 调查地区3个民族居民COPD患病、知晓及治疗现状[n(%)]
Table 2. Prevalence, awareness and treatment of COPD among three ethnics in the investigated areas [n(%)]
变量 汉族 纳西族 白族 患病率 知晓率 治疗率 患病率 知晓率 治疗率 患病率 知晓率 治疗率 性别 男 185(15.21) ab 26(14.05) ab 24(12.97) b 237(19.04) 42(17.72) 38(16.03) 185(16.16) a 83(44.86) 81(43.78) 女 103(8.01) b 6(5.83) b 6(5.83) b 210(16.33) 36(17.14) 34(16.19) 146(10.77) 69(47.26) 68(46.58) 年龄(岁) 35~ < 45 17(6.30) ab 1(5.88) ab 1(5.88) ab 57(12.67) a 3(5.26) a 2(3.51) a 11(3.77) a 2(18.18) 2(18.18) 45~ < 55 39(6.61) 0(0.00) 0(0.00) 99(14.18) 16(16.16) 14(14.14) 42(7.11) 19(45.24) 19(45.24) 55~ < 65 59(10.00) 3(5.08) 3(5.08) 101(16.50) 15(14.85) 15(14.85) 73(12.50) 32(43.84) 32(43.84) 65~ < 75 100(14.29) 13(13.00) 13(13.00) 116(23.63) 27(23.28) 26(22.41) 104(17.48) 53(50.96) 51(49.04) ≥75 73(20.74) 15(20.55) 13(17.81) 74(26.43) 17(22.97) 15(20.27) 101(23.01) 46(45.54) 45(44.55) 文化程度 小学及以下 202(11.88) b 17(8.42) ab 16(7.92) ab 294(18.01) 35(11.90) a 32(10.88) a 172(12.20) 68(39.53) a 67(38.95) a 初中及以上 86(10.74) 15(17.44) 14(16.28) 153(17.02) 43(28.10) 40(26.14) 159(14.57) 84(52.83) 82(51.57) 医疗服务可及性(min) ≥30 94(12.93) b 11(11.70) b 10(10.64) b 177(18.93) 34(19.21) 29(16.38) 25(11.79) 9(36.00) 9(36.00) ＜30 194(10.93) 21(10.82) 20(10.31) 270(16.92) 44(16.30) 43(15.93) 306(13.37) 143(46.73) 140(45.75) 家庭年人均收入(元) ≤5 700 137(11.58) b 15(10.95) b 13(9.49) b 239(18.24) 33(13.81) a 30(12.55) a 154(12.37) 67(43.51) 66(42.86) >5 700 151(11.44) 17(11.26) 17(11.26) 208(17.04) 45(21.63) 42(20.19) 177(14.09) 85(48.02) 83(46.89) 合计 288(11.51) 32(11.11) 30(10.42) 447(17.66) 78(17.45) 72(16.11) 331(13.23) 152(45.92) 149(45.02) 注：a各民族内进行比较，P＜0.05，b 3个民族间进行比较，P＜0.05。
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表 3 调查地区COPD患者分性别的死亡率、每千人口YLL、YLD和DALY值
Table 3. Mortality, YLL, YLD and DALY rates of COPD by sex in the investigated areas
民族 死亡率/10万 YLL/1 000 YLD/1 000 DALY/1 000 汉族 110.06 9.75 44.62 54.37 男 132.17 11.91 58.98 70.89 女 87.29 7.63 31.04 38.67 纳西族 58.51 17.25 68.68 85.93 男 59.07 18.24 73.72 91.96 女 57.89 16.22 63.24 79.46 白族 102.52 8.22 51.22 59.44 男 125.28 9.44 62.86 72.30 女 79.28 6.98 41.90 48.88
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