贵州省40岁及以上人群慢性阻塞性肺疾病流行及影响因素

黄露; 王艺颖; 刘涛; 李凌; 杨敬源

doi:10.16462/j.cnki.zhjbkz.2022.05.007

贵州省40岁及以上人群慢性阻塞性肺疾病流行及影响因素

doi: 10.16462/j.cnki.zhjbkz.2022.05.007

黄露¹,
王艺颖²,
刘涛²,
李凌²,
杨敬源^1, ,

1.
550025 贵阳，贵州医科大学公共卫生与健康学院流行病与卫生统计学系，环境污染与疾病监控教育部重点实验室
2.
550004 贵阳，贵州省疾病预防控制中心慢性病防治研究所

详细信息

通讯作者:
杨敬源，E-mail: yangjingyuan@gmc.edu.cn

中图分类号: R181.1;R563.9
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出版历程
- 收稿日期: 2021-09-09
- 修回日期: 2022-02-09
- 网络出版日期: 2022-05-11
- 刊出日期: 2022-05-10

An analysis in the prevalence and influencing factors of COPD among people aged 40 years and above in Guizhou Province

1.
School of Public Health, the Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Guiyang 550025, China
2.
Department of Noncommunicable Chronic Disease Control and Prevention, Guizhou Center for Chronic Disease Control and Prevention; Institute of Chronic Disease Prevention and Treatment, Guiyang 550004, China

More Information

Corresponding author: YANG Jing-yuan, E-mail: yangjingyuan@gmc.edu.cn

摘要

摘要: 目的分析研究贵州省40岁及以上不同性别人群慢性阻塞性肺疾病(chronic obstructive pulmonary disease, COPD)流行状况及其影响因素，为COPD预防提供依据。方法采用多阶段分层整群抽样方法，抽取贵州省COPD监测地区2 599名40岁及以上常住居民，进行问卷调查、体格及肺功能检查。结果贵州省监测地区COPD患病率为10.7%，男性患病率(13.0%)高于女性(7.6%)(χ²=16.951, P＜0.001)。Logistic回归分析模型分析结果显示，在男性人群中，年龄、吸烟、肺结核、慢性支气管炎病史与COPD患病密切相关；而女性人群中，年龄、脑血管、肺气肿病史、慢性支气管炎病史、鼻炎与COPD患病密切相关。结论贵州省监测地区COPD患病率及影响因素存在性别差异，为降低COPD患病率，男性以控烟和采取呼吸系统疾病筛查为主要措施，女性重点加强呼吸系统疾病筛查。
- 慢性阻塞性肺疾病 /
- 性别差异 /
- 患病率 /
- 影响因素
Abstract: Objective To explore the gender comparison in prevalence and influencing factors of chronic obstructive pulmonary disease (COPD) among people aged 40 years and above in Guizhou Province, to provide basis for risk stratification and prevention of COPD. Methods A total of 2 599 residents aged 40 years and over in the COPD monitored area of Guizhou Province was selected according to a multi-stage stratified cluster sampling method. And all participants were underwent a questionnaire survey, physical examination, and lung function test. Results The total prevalence of COPD in the monitored area of Guizhou Province was 10.7%. The prevalence of male (13.0%) was higher than that of female (7.6%) (χ²=16.951, P < 0.001). Unconditional multivariate Logistic regression analysis suggested that age, smokers, tuberculosis, and history of chronic bronchitis were significantly associated with COPD in male population; While age, cerebrovascular diseases, history of emphysema, history of chronic bronchitis, and rhinitis were significantly associated with COPD in the female. Conclusions The prevalence and influencing factors of COPD were different between male and female. In order to reduce the incidence of COPD, smoking control and respiratory disease screening are main measures for men, and respiratory disease screening is the main measure for women.
- Chronic obstructive pulmonary disease /
- Gender difference /
- Prevalence /
- Influencing factors

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图 1 不同性别患病率随年龄的变化趋势

Figure 1. The trend of prevalence according to the increasing age in different genders

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表 1 贵州省监测地区40岁及以上COPD调查人口基本情况

Table 1. Basic characteristics of COPD investigation population aged 40 years old and above in Guizhou monitoring area

变量	总人群		男性		女性		χ²值	P值
变量	人数	构成比(%)	人数	构成比(%)	人数	构成比(%)	χ²值	P值
年龄组(岁)							13.702	0.003
40~ < 50	1 041	40.05	622	42.75	419	36.62
50~ < 60	796	30.63	444	30.51	352	30.77
60~ < 70	583	22.43	300	20.62	283	24.74
≥70	179	6.89	89	6.12	90	7.87
民族							1.574	0.215
汉族	2 146	82.57	1 189	81.72	957	83.65
少数民族	453	17.43	266	18.28	187	16.35
文化程度^a							33.495	0.001
低水平	2 356	90.69	1276	87.76	1 080	94.41
高水平	242	9.31	178	12.24	64	5.59
婚姻^a							12.205	0.001
无配偶(未婚、分居、离异丧偶)	318	12.24	149	10.25	169	14.77
有配偶(已婚、同居)	2 280	87.76	1 305	89.75	975	85.23
吸烟情况^a							1705.917	0.001
不吸烟	1 257	48.46	182	12.53	1 075	94.13
戒烟	190	7.32	172	11.85	18	1.58
吸烟	1 147	44.22	1 098	75.62	49	4.29
BMI等级^a							19.995	0.001
体重过低	60	2.34	37	2.58	23	2.04
正常	1 308	51.07	786	54.73	522	46.40
超重	719	28.08	369	25.70	350	31.11
肥胖	474	18.51	244	16.99	230	20.45
COPD患病情况^a							16.951	0.001
未患病	2 013	89.27	1 127	86.96	886	92.39
患病	242	10.73	169	13.04	73	7.61
母亲怀孕时是否吸烟^a							4.389	0.111
否	1 971	91.59	1 081	91.15	890	92.13
是	181	8.41	105	8.85	76	7.87
14岁以前因患肺炎或支气管炎而住院^a							4.499	0.105
否	2 322	97.77	1 283	97.49	1 039	98.11
是	53	2.23	33	2.51	20	1.89
家庭使用取暖污染燃料^a							0.126	0.722
否	2 152	82.83	1 201	82.60	951	83.13
是	446	17.17	253	17.40	193	16.87
14岁前曾与每天吸烟者共同生活^a							50.219	0.001
否	1 353	54.76	668	48.44	685	62.73
是	1 118	45.24	711	51.56	407	37.27
经常接触做饭油烟^a							289.591	0.001
否	1 163	44.77	865	59.49	298	26.05
是	1 435	55.23	589	40.51	846	73.95
冬季最主要取暖形式及燃料^a							7.914	0.161
不取暖	24	0.92	19	1.31	5	0.44
集中供暖	22	0.85	14	0.96	8	0.70
电(电暖器/电热风/空调)	399	15.36	219	15.06	180	15.74
煤/煤球/煤饼/炭	2 002	77.06	1 111	76.41	891	77.88
木头/柴草/农作物秸秆	150	5.77	90	6.19	60	5.24
其他	1	0.04	1	0.07	0	0
注：^a有数据缺失。

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表 2 贵州省监测地区不同性别COPD危险因素的单因素分析结果[n(%)]

Table 2. Univariate analysis for the risk factors of COPD in different genders of Guizhou monitoring areas [n(%)]

变量	总人群^a			男			女
变量	患病人数(%)	χ²值	P值	患病人数(%)	χ²值	P值	患病人数(%)	χ²值	P值
性别		16.951	＜0.001
男	169(13.0)
女	73(7.6)
年龄分组(岁)		95.998	＜0.001		65.103	＜0.001		41.84	＜0.001
40~ < 50	45(4.8)			34(6.0)			11(3.0)
50~ < 60	74(10.6)			51(13.1)			23(7.4)
60~ < 70	88(18.0)			63(23.9)			25(11.1)
≥70	35(26.7)			21(26.9)			14(26.4)
民族		1.618	0.203		3.171	0.075		0.038	0.845
汉族	208(11.1)			147(13.8)			61(7.5)
少数民族	34(8.9)			22(9.5)			12(8.0)
文化程度		3.428	0.064		1.874	0.171		5.274	0.022
低水平	226(11.1)			153(13.5)			73(8.1)
高水平	16(7.1)			16(9.7)			0(0.0)
婚姻		1.432	0.231		2.143	0.143		0.331	0.565
无配偶	34(12.9)			22(17.2)			12(8.8)
有配偶	208(10.5)			147(12.6)			61(7.4)
BMI等级		15.025	0.002		16.313	＜0.001		8.103	0.044
过低	9(22.5)			6(23.1)			3(21.4)
正常	137(12.0)			111(15.7)			26(5.9)
超重	67(10.5)			37(10.9)			30(10.0)
肥胖	29(6.7)			15(6.7)			14(6.8)
吸烟情况		26.117	＜0.001		7.627	0.022		2.473	0.292
不吸烟	78(7.3)			11(6.7)			67(7.4)
戒烟	27(16.5)			24(16.3)			3(17.6)
吸烟	137(13.4)			134(13.7)			3(7.3)
14岁前曾与每天吸烟者共同生活		3.291	0.071		1.202	0.273		0.454	0.501
否	107(9.3)			69(11.6)			38(6.7)
是	115(11.7)			87(13.7)			28(7.9)
家庭取暖使用污染燃料		13.401	＜0.001		8.332	0.004		5.498	0.019
否	21(5.5)			16(7.1)			5(3.1)
是	221(11.8)			153(14.3)			68(8.5)
经常接触做饭油烟		0.006	0.943		2.426	0.121		0.176	0.675
否	108(10.7)			91(11.8)			17(7.0)
是	134(10.8)			78(14.8)			56(7.8)
冬季最主要取暖形式及燃料		16.209	0.003		11.805	0.019		9.612	0.048
不取暖	2(10.0)			1(5.9)			1(33.3)
集中供暖	3(14.3)			3(23.1)			0(0.0)
电	16(4.7)			12(6.2)			4(2.7)
煤/煤球/煤饼/炭	204(11.7)			141(14.1)			63(8.4)
木头/柴草/农作物秸秆	17(13.6)			12(16.7)			5(9.4)
肺间质纤维化		16.643	＜0.001		13.346	＜0.001		6.148	0.130
否	240(10.7)			167(12.9)			73(7.6)
是	2(100.0)			2(100.0)			0(0.0)
14岁以前因患肺炎或支气管炎而住院		2.430	0.297		0.586	0.746		2.614	0.271
否	211(10.5)			148(12.9)			63(7.2)
是	8(17.0)			5(17.9)			3(15.8)
支气管扩张症		21.104	＜0.001		13.456	＜0.001		5.681	0.070
否	233(10.4)			162(12.7)			71(7.5)
是	9(40.9)			7(43.8)			2(33.3)
骨质疏松		2.731	0.098		0.113	0.737		6.222	0.013
否	226(10.5)			161(13.0)			65(7.1)
是	16(15.7)			8(14.5)			8(17.0)
抑郁症		3.205	0.073		0.214	0.644		12.152	0.076
否	240(10.7)			168(13.0)			72(7.5)
是	2(33.3)			1(20.0)			1(100.0)
脑血管病		2.440	0.118		1.337	0.248		19.151	＜0.001
否	232(10.6)			167(13.2)			65(7.0)
是	10(16.9)			2(6.3)			8(29.6)
冠心病		3.545	0.064		0.282	0.595		6.687	0.025
否	233(10.6)			165(13.0)			68(7.3)
是	9(19.1)			4(16.7)			5(21.7)
慢性肺源性心脏病		1.244	0.265		0.214	0.644		1.727	0.272
否	240(10.7)			168(12.97)			72(7.5)
是	2(22.2)			1(20.0)			1(25.0)
肺结核		8.069	0.008		7.595	0.006		0.234	0.629
否	229(10.4)			158(12.6)			71(7.6)
是	13(22.0)			11(27.5)			2(10.5)
肺气肿病史		39.685	＜0.001		14.036	＜0.001		33.049	＜0.001
否	226(10.2)			160(12.6)			66(7.0)
是	16(42.1)			9(39.1)			7(46.7)
慢性支气管炎病史		71.123	＜0.001		28.378	＜0.001		49.171	＜0.001
否	178(8.8)			128(11.2)			50(5.7)
是	64(26.7)			41(26.6)			23(26.7)
哮喘		37.865	＜0.001		16.224	＜0.001		26.135	＜0.001
否	221(10.1)			157(12.4)			64(6.9)
是	21(35.0)			12(36.4)			9(33.3)
鼻炎		6.501	0.011		2.661	0.103		5.121	0.034
否	225(10.4)			159(12.8)			66(7.2)
是	17(18.9)			10(20.8)			7(16.7)
注：^a 344人因未完成肺功能检测而未纳入。

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表 3 贵州省监测地区不同性别COPD危险因素的多因素分析结果

Table 3. Multivariate analysis for the risk factors of COPD in different genders of Guizhou monitoring areas

变量	β值	Wald值	OR(95% CI)值	P值	变量	β值	Wald值	OR(95% CI)值	P值
总体					男
年龄分层(岁)					年龄分层(岁)
40~<50			1.00		60~<70	1.534	43.360	4.63(2.93~7.32)	＜0.001
50~ < 60	0.811	16.294	2.23(1.51~3.29)	＜0.001	≥70	1.812	31.550	6.12(3.25~11.5)	＜0.001
60~ < 70	1.369	50.125	4.05(2.75~5.97)	＜0.001	不吸烟			1.00
≥70	1.911	53.954	6.68(4.02~11.0)	＜0.001	戒烟	0.878	6.821	2.15(0.98~4.71)	0.054
不吸烟			1.00		吸烟	0.728	3.312	2.14(1.10~4.17)	0.024
戒烟	0.758	23.507	2.13(1.57~2.89)	＜0.001	肺结核	1.064	7.502	2.89(1.35~6.20)	0.006
吸烟	0.627	5.988	1.87(1.13~3.09)	0.014	慢性支气管炎病史	0.824	14.058	2.27(1.48~3.50)	＜0.001
家庭取暖使用污染燃料	0.504	4.277	1.65(1.02~2.66)	0.039	女
肺间质纤维化	0.006	8.610	1.00(1.00~1.01)	0.003	年龄分层(岁)
肺结核	0.753	4.642	2.12(1.07~4.21)	0.031	40~ < 50			1.00
肺气肿病史	0.879	5.256	2.40(1.13~5.10)	0.022	50~ < 60	0.786	4.142	2.19(1.02~4.67)	0.042
慢性支气管炎病史	0.958	26.404	2.60(1.80~3.75)	＜0.001	60~ < 70	1.191	9.536	3.29(1.54~7.01)	0.002
鼻炎	0.623	4.280	1.86(1.03~3.36)	0.039	≥70	2.310	25.099	10.0(4.08~24.80)	＜0.001
男					脑血管病	0.988	4.009	2.68(1.02~7.06)	0.045
年龄分层(岁)					肺气肿病史	1.626	7.344	5.08(1.56~16.40)	0.007
40~ < 50			1.00		慢性支气管炎病史	1.304	15.821	3.68(1.93~7.00)	＜0.001
50~ < 60	0.820	12.011	2.27(1.42~3.60)	＜0.001	鼻炎	0.993	4.311	2.69(1.05~6.88)	0.038

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