Association between passive smoking exposure and insomnia in a Tibetan non-smoking population based on the propensity score
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摘要:
目的 描述中国藏族非吸烟人群被动吸烟暴露与失眠症状的分布特征，探究被动吸烟暴露与失眠症状的关联程度。 方法 基于“西南区域自然人群队列”项目2018年5月―2019年8月在拉萨市调查的7 737名藏族居民数据，采用倾向性评分逆概率加权法和边际结构模型分析被动吸烟暴露与失眠症状的关联，并比较该关联在不同年龄、性别、BMI、负性生活事件、社会支持组别之间的差异。 结果 调查人群中被动吸烟暴露率为22.50%，失眠检出率为33.67%。利用倾向性评分均衡潜在混杂因素后，被动吸烟暴露组发生失眠症状的风险为非被动吸烟暴露组的1.24倍(OR=1.24, 95% CI: 1.14~1.34)；年龄≥50岁(OR=1.25, 95% CI: 1.01~1.54)、男性(OR=1.60, 95% CI: 1.17~2.18)、超重(OR=1.24, 95% CI: 1.05~1.47)、有过1次负性生活事件(OR=1.46, 95% CI: 1.01~2.10)和中等社会支持(OR=1.46, 95% CI: 1.12~1.92)人群被动吸烟暴露与失眠有显著关联。 结论 在藏族非吸烟人群中被动吸烟暴露是失眠的危险因素，应该采取相关降低被动吸烟暴露的干预措施去促进人群睡眠健康。 Abstract:Objective To describe the distribution characteristics of passive smoking exposure and insomnia symptoms in the Tibetan non-smoking population in China. It aims to investigate the extent of association between passive smoking exposure and insomnia symptoms. Methods Based on the data of 7 737 Tibetan residents recruited in Lhasa from 2018 to 2019 in the Southwest Regional General Population Cohort Project, the study analyzed the association between passive smoking exposure and insomnia symptoms using the propensity score inverse probability weighting method and marginal structure model. Besides, the association between passive smoking and insomnia was compared across age, gender, BMI, adverse life events, and social support groups. Results The passive smoking exposure rate was 22.50%, and the insomnia detection rate was 33.67% in the survey population. After adjusting for potential confounders, the risk of insomnia symptoms in the passive smoking group was nearly 1.24 times higher than in the non-passive smoking exposed group (OR=1.24, 95% CI: 1.14-1.34). People who age ≥50 years (OR=1.25, 95% CI: 1.01-1.54), was males (OR=1.60, 95% CI: 1.17-2.18), overweight (OR=1.24, 95% CI: 1.05-1.47), have had an adverse life event (OR=1.46, 95% CI: 1.01-2.10) and moderate social support (OR=1.46, 95% CI: 1.12-1.92) were suffered more strongly effect of passive smoking exposure on insomnia. Conclusions This study suggests that passive smoking exposure is a risk factor for insomnia in the Tibetan non-smoking population. Interventions regarding reducing passive smoking exposure should be performed to promote sleep health in Tibetans. -
Key words:
- Tibetan population /
- Passive smoking /
- Exposure /
- Insomnia /
- Propensity score methods
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表 1 根据是否暴露于被动吸烟分层的研究对象基本特征[n(%)]
Table 1. The characteristics of the study population across the prevalence of passive smoking[n(%)]
变量 被动吸烟暴露 t/χ2值 P值 无 有 人数 4 71677.5) 1 36922.5) 年龄(x±s, 岁) 47.20±13.8 44.78±13.2 5.916 < 0.001 性别 68.758 < 0.001 男 1 487(31.5) 273(19.9) 女 3 229(68.5) 1 096(80.1) 家庭年收入(万元) 68.131 < 0.001 < 2 2 578(54.7) 575(42.0) 2~＜10 1 841(39.1) 680(49.7) ≥10 295(6.3) 113(8.3) 教育程度 9.179 0.010 未正规上过学及小学 3 826(81.1) 1 060(77.4) 初中及高中 626(13.3) 217(15.9) 大专及以上 264(5.6) 92(6.7) 戒烟情况 0.552 0.457 以前吸，现在戒烟 4 428(93.9) 1 294(94.5) 从不吸烟 286(6.1) 75(5.5) 饮酒情况 67.647 < 0.001 从不饮酒 3 554(75.4) 885(64.6) 偶尔饮酒 1 000(21.2) 436(31.8) 经常饮酒 162(3.4) 48(3.5) 体力活动 20.35(16.3) 21.91(16.5) -3.080 0.002 BMI(kg/m2) 11.934 0.003 < 24 1 073(27.6) 385(32.7) 24~ < 28 2 128(54.8) 589(50.0) ≥28 681(17.5) 203(17.2) 负性生活事件 3.732 0.155 从未有过 3 949(83.7) 1 122(82.0) 有过1次 627(13.3) 194(14.2) 有过1次以上 140(3.0) 53(3.9) 社会支持 24.834 < 0.001 低社会支持需要 1 763(37.4) 420(30.7) 中社会支持需要 1 163(24.7) 408(29.8) 高社会支持需要 1 790(38.0) 541(39.5) 失眠 7.195 0.007 无 3 171(67.1) 865(63.2) 有 1 545(32.9) 504(36.8) 
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表 2 IPW前后暴露组与非暴露组协变量的STD
Table 2. Standardized difference of covariates between people with and without passive smoking before and after inverse probability weighting
人群特征 IPW前STD IPW后STD 年龄 0.161 0.008 性别 0.261 0.007 体育锻炼时长 0.093 -0.003 家庭年收入(万元) 0.255 < 2 -0.003 2~＜10 0.001 ≥10 0.002 教育程度 0.111 未正规上过学及小学 0.001 初中及高中 -0.001 大专及以上 0.001 饮酒情况 0.253 从不饮酒 0.001 偶尔饮酒 -0.002 经常饮酒 0.002 BMI 0.163 偏瘦或正常 -0.002 超重 -0.006 肥胖 0.008 负性事件 0.084 从未有过 0.001 有过1次 -0.004 有过1次以上 0.005 社会支持 0.408 低社会支持 0.010 中社会支持 -0.002 高社会支持 -0.008
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表 3 全人群及不同亚组人群中被动吸烟暴露与失眠症状关联性
Table 3. Associations between passive smoking and insomnia in whole population and subpopulation
分层变量 β值 sx值 P值 OR(95% CI)值 年龄(岁) < 50 0.171 0.100 0.080 1.19(0.98~1.44) ≥50 0.221 0.109 0.040 1.25(1.01~1.54) 性别 男 0.470 0.157 0.003 1.60(1.17~2.18) 女 0.125 0.082 0.128 1.13(0.96~1.33) BMI 未超重 0.156 0.133 0.272 1.16(0.89~1.50) 超重 0.217 0.087 0.013 1.24(1.05~1.47) 负性生活事件 从未有过 0.176 0.081 0.030 1.19(1.02~1.40) 有过1次 0.375 0.188 0.045 1.46(1.01~2.10) 有过1次以上 0.142 0.423 0.737 0.87(0.38~1.99) 社会支持 低社会支持 0.090 0.116 0.438 1.09(0.87~1.38) 中社会支持 0.381 0.138 0.006 1.46(1.12~1.92) 高社会支持 0.131 0.129 0.309 1.14(0.89~1.47) 全人群 0.196 0.073 0.007 1.22(1.05~1.40)
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