Study on influencing factors of chronic obstructive pulmonary disease based on propensity score matching
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摘要:
目的 经倾向性评分匹配(propensity score matching, PSM)均衡组间人口学特征后，研究慢性阻塞性肺疾病(chronic obstructive pulmonary disease, COPD)与生活行为习惯、个体疾病等因素的关系。 方法 使用2014―2015年山西省居民COPD监测数据，其中病例组277人，对照组1 795人。采用PSM按1:1选取在人口学特征上与病例相近的对照个体；采用条件Logistic回归分析模型分析COPD的影响因素。 结果 成功匹配275对，条件Logistic回归分析模型结果显示，知晓COPD者患病风险降低了92.8%；既往经常咳嗽、有呼吸道疾病史、接触有害气体、吸烟者患COPD的风险分别提高了1.489倍、1.371倍、1.013倍、0.834倍。 结论 加强COPD的健康教育、禁烟、不接触有害气体、及时治疗呼吸系统疾病是预防和减少COPD发生的重要措施。 Abstract:Objective To study the relationship between COPD and living habits, individual diseases, based on balanced demographic confounding factors between the case group and the control group by the PSM. Methods Data from 2014 to 2015 on COPD surveillance were first employed among residents of Shanxi Province, including 277 patients in the case group and 1 795 in the control group. Afterwards, 275 randomly matched control subjects were selected using PSM in a ratio of 1:1. Besides, conditional Logistic regression was utilized to study the influencing factors of COPD. Results The conditional Logistic regression results, based on 275 successfully matched pairs, showed a 92.8% reduction in the risk of developing COPD among those who knew about it; the risk of developing COPD was increased by 1.489 times, 1.371 times, 1.013 times and 0.834 times among those with previous frequent coughing, respiratory disease, exposure to harmful gases and smoking respectively. Conclusions Better health education, smoking ban, no exposure to harmful gases and timely treatment of respiratory diseases are important measures to prevent and reduce the occurrence of COPD. -
表 1 变量与赋值情况
Table 1. Variables and their assignments
变量名称 变量 赋值 慢性阻塞性肺疾病 Y 有=1，无=0 性别 X1 男=1，女=2 年龄(岁) X2 40~ < 50=1，50~ < 60=2，60~ < 70=3，≥70=4 BMI(kg/m2) X3 ＜18.5=1，18.5~ < 24.0=2，24.0~ < 28.0=3，
≥28.0=4居住地 X4 城市=1，农村=2 吸烟 X5 有=1，无=0 慢阻肺知晓情况 X6 知晓=1，不知晓=0 既往经常咳嗽 X7 有=1，无=0 气短或呼吸困难史 X8 有=1，无=0 呼吸道疾病史 X9 有=1，无=0 心脑血管疾病史 X10 有=1，无=0 高血压史 X11 有=1，无=0 使用污染燃料烹饪 X12 有=1，无=0 接触有害气体 X13 有=1，无=0 
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表 2 匹配前、后两组人口学的分布情况[n(%)]
Table 2. Demographic distribution of the two groups before and after matching [n(%)]
变量 匹配前 匹配后 对照组(n=1 795) 病例组(n=277) χ2值 P值 对照组(n=275) 病例组(n=275) χ2值 P值 性别 83.080 ＜0.001 0.010 0.919 男 859(47.9) 214(77.3) 211(76.7) 212(77.1) 女 936(52.1) 63(22.7) 64(23.3) 63(22.9) 年龄(岁) 39.202 ＜0.001 3.319 0.345 40~ < 50 701(39.1) 58(20.9) 62(22.5) 58(21.1) 50~ < 60 617(34.4) 109(39.4) 90(32.7) 109(39.6) 60~ < 70 397(22.1) 87(31.4) 103(37.5) 87(31.6) ≥70 80(4.5) 23(8.3) 20(7.3) 21(7.6) 居住地 11.555 0.001 2.646 0.104 城市 955(53.2) 117(42.2) 135(49.1) 116(42.2) 农村 840(46.8) 160(57.8) 140(50.9) 159(57.8) BMI(kg/m2) 37.433 ＜0.001 0.017 0.999 ＜18.5 9(0.5) 7(2.5) 5(1.8) 5(1.8) 18.5~ < 24.0 554(30.8) 121(43.7) 120(43.6) 121(44.0) 24.0~ < 28.0 798(44.5) 111(40.1) 111(40.4) 111(40.4) ≥28.0 434(24.2) 38(13.7) 39(14.2) 38(13.8)
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表 3 匹配后影响因素的单因素分析
Table 3. Univariate analysis of influencing factors after matching
变量 暴露人数 暴露比例 χ2值 P值 对照组(n=275) 病例组(n=275) 对照组(%) 病例组(%) 吸烟 162 182 58.9 66.2 3.105 0.078 COPD知晓情况 94 11 34.2 4.0 81.090 ＜0.001 既往经常咳嗽 18 53 6.5 19.3 19.811 ＜0.001 气短或呼吸困难史 40 80 14.5 29.1 17.054 ＜0.001 呼吸道疾病史 30 65 10.9 23.6 15.587 ＜0.001 心脑血管疾病史 15 22 5.5 8.0 1.420 0.233 高血压史 56 51 20.4 18.5 0.290 0.590 使用污染燃料烹饪 130 157 47.3 57.1 5.312 0.021 接触有害气体 58 80 21.1 29.1 4.682 0.030
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表 4 慢阻肺危险因素的条件Logistic回归分析
Table 4. Conditional Logistic regression analysis of risk factors for COPD
变量 $\widehat{\beta}_{j}$值 sbj值 Wald值 OR(95% CI)值 P值 COPD知晓情况 -2.631 0.410 41.087 0.072(0.032~0.161) ＜0.001 既往经常咳嗽 0.912 0.381 5.726 2.489(1.179~5.255) 0.017 呼吸道疾病史 0.863 0.311 7.683 2.371(1.288~4.366) 0.006 接触有害气体 0.700 0.256 7.493 2.013(1.220~3.323) 0.006 吸烟 0.607 0.279 4.738 1.834(1.062~3.168) 0.030
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