云南省农村居民慢性阻塞性肺疾病患病现况及基于结构方程模型的影响因素

刘岚; 王旭明; 李锦波; 莫怡; 李国晖; 黄友; 李芹; 左梅; 蔡乐

doi:10.16462/j.cnki.zhjbkz.2022.11.016

云南省农村居民慢性阻塞性肺疾病患病现况及基于结构方程模型的影响因素

doi: 10.16462/j.cnki.zhjbkz.2022.11.016

刘岚¹,
王旭明²,
李锦波¹,
莫怡¹,
李国晖¹,
黄友¹,
李芹¹,
左梅¹,
蔡乐^1, ,

1.
650500 昆明, 昆明医科大学公共卫生学院
2.
650032 昆明, 昆明医科大学第一附属医院呼吸与危重症医学科

刘岚与王旭明为共同第一作者

基金项目:

国家自然科学基金 72064026

云南省创新团队培育计划 202005AE160002

云南省科技厅昆医联合专项资助项目 202101AY070001-098

详细信息

通讯作者:
蔡乐, E-mail: caile002@hotmail.com

中图分类号: R563;R181
计量
- 文章访问数: 266
- HTML全文浏览量: 123
- PDF下载量: 32
- 被引次数: 0
出版历程
- 收稿日期: 2022-02-28
- 修回日期: 2022-06-17
- 网络出版日期: 2022-12-21
- 刊出日期: 2022-11-10

Analysis of prevalence and determinants of chronic obstructive pulmonary disease in rural Yunnan Province based on structure equation modeling

LIU Lan¹,
WANG Xu-ming²,
LI Jin-bo¹,
MO Yi¹,
LI Guo-hui¹,
HUANG You¹,
LI Qin¹,
ZUO Mei¹,
CAI Le^{1
, ,}

1.
School of Public Health, Kunming Medical University, Kunming 650500, China
2.
Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Kunming Medical University, Kunming 650032, China

LIU Lan and WANG Xu-ming contributed equally to this work

Funds:

National Natural Science Foundation of China 72064026

Program for Innovation Team of Yunnan Province 202005AE160002

Union Specific Project Foundation of Yunnan Provincial Science and Technology Department and Kunming Medical University 202101AY070001-098

More Information

Corresponding author: CAI Le, E-mail: caile002@hotmail.com

摘要

摘要: 目的分析云南省农村居民慢性阻塞性肺疾病(chronic obstructive pulmonary disease，COPD)患病现况及其影响因素。方法采用多阶段分层随机抽样方法抽取云南省农村地区7 572名≥35岁常住居民进行现场问卷调查和体格检查，采用主成分分析法(principal component analysis，PCA)构建个体社会经济地位(socioeconomic status，SES)，运用结构方程模型(structure equation modeling，SEM)分析COPD患病的影响因素。结果云南省农村居民COPD患病率为12.60%，男性患病率高于女性(χ² =57.973，P＜0.001)；COPD患病率随年龄的增加而升高(χ_趋势²=165.616，P＜0.001)；少数民族居民COPD患病率高于汉族居民(χ²=33.785，P＜0.001)；SES越低，COPD患病率越高(χ_趋势²=10.751，P＜0.001)。SEM分析结果显示，性别、年龄、民族和SES对COPD患病具有直接和间接作用，其总路径系数分别为0.09、0.15、0.06和-0.05，而COPD家族史、低BMI、现在吸烟和被动吸烟对COPD患病只有直接作用, 其路径系数分别为0.06、0.03、0.08和0.08。结论云南省农村居民COPD患病率较高，应加强对男性、高龄、吸烟、低BMI、有COPD家族史和SES较低人群的COPD健康教育和干预工作。
- 慢性阻塞性肺疾病 /
- 患病率 /
- 结构方程模型 /
- 影响因素
Abstract: Objective The aim of this study was to analyze the prevalence and determinants of chronic obstructive pulmonary disease (COPD) in rural areas of Yunnan Province. Methods The multi-stage stratified random sampling method was used to conduct on-site questionnaire survey and physical examination among 7 572 rural residents aged ≥35 years from three counties in Yunnan Province. Principal component analysis was used to construct individual socioeconomic status (SES). Structure Equation Modeling (SEM) was used to analyze possible influencing factors of prevalence of COPD. Results Among the study population, the prevalence of COPD was 12.60%. Males had a significantly higher prevalence of COPD than females (15.54% and 9.73%, χ² =57.973, P < 0.001). Prevalence of COPD increased with age (χ_trend²=165.616, P < 0.001). Ethnic minority groups had a higher prevalence of COPD than Han majority (χ_trend²=33.785, P < 0.001). Individuals with lower SES had a higher prevalence of COPD than their counterparts (χ² =10.751, P < 0.001). The results of SEM analysis indicated that the following associated factors had both direct and indirect statistically significant effect on prevalence of COPD: gender (0.09), age (0.15), ethnicity (0.06), and SEP (-0.05) had both direct and indirect effects on prevalence of COPD, whereas family history of COPD (0.06), low BMI (0.03), current smoking (0.08), and passive smoking (0.08) only directly associated with prevalence of COPD. Conclusions The prevalence of COPD is high in rural Yunnan Province. Future health education and intervention to prevent and control COPD should focus on males, elderly people, current smokers, individuals with low BMI, and individuals with family history of COPD and low SES.
- Chronic obstructive pulmonary disease /
- Prevalence /
- Structural equation modeling /
- Influencing factors

HTML全文

图 1 云南省农村居民COPD患病影响因素的结构方程模型

Figure 1. Structure equation modeling on determinants of COPD in rural Yunnan Province

下载: 全尺寸图片幻灯片

表 1 云南省农村居民SES的PCA

Table 1. PCA of SES among rural residents in Yunnan

统计指标	数值
KMO统计值	0.700
Bartlett's球形检验
近似χ²值	122.768
P值	＜0.001
特征根	1.149

下载: 导出CSV

表 2 云南省农村居民分性别、民族的SES分布情况[n(%)]

Table 2. Distribution of SES by sex and ethnicity in rural Yunnan Province [n(%)]

组别	SES分组				χ²值	P值
组别	低	中等偏下	中等偏上	高	χ²值	P值
性别					4.628	＜0.001
男	826 (22.09)	860 (23.00)	987 (26.40)	1 066(28.51)
女	1 037 (27.05)	955 (24.92)	1 039(27.11)	802(20.92)
民族					3.914	＜0.001
汉族	932 (22.60)	960 (23.28)	1 218 (29.53)	1 014(24.59)
少数民族	931 (27.00)	855 (24.80)	808 (23.43)	854(24.77)
合计	1 863 (24.60)	1 815 (23.97)	2 026 (26.76)	1 868(24.67)

下载: 导出CSV

表 3 云南省农村居民分性别、民族的SES分布情况

Table 3. Distribution of SES by sex and ethnicity in rural Yunnan Province

组别	患病人数(n)	患病率(%)	χ²值	P值	组别	患病人数(n)	患病率(%)	χ²值	P值
性别			57.973	＜0.001	SES			11.777	0.008
男	581	15.54			低	259	13.9
女	373	9.73			中等偏下	251	13.83
年龄组(岁)			171.386	＜0.001	中等偏上	243	11.99
35~＜45	83	6.61			高	201	10.76
45~＜55	167	8.77			COPD家族史			23.519	＜0.001
55~＜65	223	12.02			是	22	31.88
65~＜75	284	17.01			否	932	12.42
≥75	197	22.26			低BMI			22.308	＜0.001
民族			33.785	＜0.001	是	77	20.48
汉族	436	10.57			否	877	12.19
少数民族	518	15.02			现在吸烟			72.668	＜0.001
受教育程度			4.146	0.032	是	479	16.78
文盲	241	13.93			否	475	10.07
小学及以上	713	12.2			被动吸烟			34.204	＜0.001
家庭年人均收入			15.422	＜0.001	是	251	17.16
低	541	14.07			否	703	11.51
高	413	11.08
医疗服务可及性			4.904	0.028
差	333	13.68
好	621	12.09

下载: 导出CSV

表 4 云南省农村居民COPD患病影响因素的SEM的拟合度

Table 4. The fit of the SEM of determinants of COPD in rural Yunnan Province

统计检验量	适配标准或临界值	最终模型指标	拟合度
绝对适配度指数
良适性适配指数	>0.90	0.998	符合
调整后良适性适配指数	>0.90	0.995	符合
渐进残差均方和平方根	< 0.08(适配合理) < 0.05(适配良好)	0.017	适配良好
残差均方和平方根	< 0.05	0.003	符合
增值适配度指数
规准适配指数	>0.90	0.989	符合
相对适配指数	>0.90	0.977	符合
增值适配指数	>0.90	0.993	符合
非规准适配指数	>0.90	0.984	符合
比较适配指数	>0.90	0.993	符合
简约适配度指数
临界样本数	＞200	3 475	符合
一致性赤池信息量准则值	理论模型小于独立模型，且小于饱和模型	482.01＜655.53＜8 026.08	符合

下载: 导出CSV

表 5 各变量对COPD患病的直接、间接作用及作用路径系数

Table 5. Direct and indirect effects and path coefficients of each variable on COPD

组别	直接作用	路径系数	间接作用	路径系数	总路径系数
性别	性别→COPD	0.06 ^a	性别→SES、现在吸烟、被动吸烟→COPD	0.03 ^a	0.09 ^a
年龄(岁)	年龄→COPD	0.15 ^a	年龄→低BMI→COPD	0.003 ^a	0.15 ^a
民族	民族→COPD	0.05 ^a	民族→SES→COPD	0.01 ^a	0.06 ^a
受教育程度	SES→COPD	-0.01 ^b			-0.01 ^b
家庭人均年收入	SES→COPD	-0.01 ^b			-0.01 ^b
医疗服务可及性	SES→COPD	-0.02 ^b			-0.02 ^b
SES	SES→COPD	-0.04 ^b	SES→低BMI、现在吸烟、被动吸烟→COPD	-0.01 ^b	-0.05 ^b
COPD家族史	COPD家族史→COPD	0.06 ^a			0.06 ^a
低BMI	低BMI→COPD	0.03 ^a			0.03 ^a
现在吸烟	现在吸烟→COPD	0.08 ^a			0.08 ^a
被动吸烟	被动吸烟→COPD	0.08 ^a			0.08 ^a
注: ^aP＜0.001; ^bP＜0.05。

下载: 导出CSV

参考文献(19)

[1]	中华医学会呼吸病学分会慢性阻塞性肺疾病学组, 中国医师协会呼吸医师分会慢性阻塞性肺疾病工作委员会. 慢性阻塞性肺疾病诊治指南(2021年修订版)[J]. 中华结核和呼吸杂志, 2021, 44(3): 170-205. DOI: 10.3760/cma.j.cn112147-20210109-00031. Chronic Obstructive Pulmonary Disease Committee, Respiratory Society, Chinese Medical Association. Guidelines for the diagnosis and management of chronic obstructive pulmonary disease (revised version 2021)[J]. Chin J Tuberc Respir Dis, 2021, 44(3): 170-205. DOI: 10.3760/cma.j.cn112147-20210109-00031.
[2]	Zhong NS, Wang C, Yao WZ, et al. Prevalence of chronic obstructive pulmonary disease in China: a large, population-based survey[J]. Am J Respir Crit Care Med, 2007, 176(8): 753-760. DOI: 10.1164/rccm.200612-1749OC.
[3]	Wang C, Xu JY, Yang L, et al. Prevalence and risk factors of chronic obstructive pulmonary disease in China (the China Pulmonary Health[CPH] Study): a national cross-sectional study[J]. Lancet, 2018, 391(10131): 1706-1717. DOI: 10.1016/S0140-6736(18)30841-9.
[4]	李凡, 孙惠芬, 段静, 等. 从GOLD指南的演变看慢性阻塞性肺疾病的防治[J]. 中国全科医学, 2019, 22(27): 3275-3280. DOI: 10.12114/j.issn.1007-9572.2019.00.383. Li F, Sun HF, Duan J, et al. Prevention and treatment of chronic obstructive pulmonary disease from the evolution of GOLD[J]. Chin Genl Pract, 2019, 22(27): 3275-3280. DOI: 10.12114/j.issn.1007-9572.2019.00.383.
[5]	卞玉梅. 结构方程模型研究及其应用[D]. 大连: 大连海事大学, 2017. Bian YM. Research and application of structural equation model[D]. Dalian: DalianMaritime University, 2017.
[6]	吴明隆. 结构方程模型[M]. 重庆: 重庆大学出版社, 2013: 1-53. Wu ML. Structural Equation Model[M]. Chongqing: Chongqing University Press, 2013: 1-53.
[7]	云南省统计局. 云南统计年鉴-2019(总第35期)[M]. 北京: 中国统计出版社, 2019: 23-29. Yunnan Bureau of statistics. Yunnan statistical yearbook 2019[M]. Beijing: China Statistics Press, 2019: 23-29.
[8]	Cai L, Wang XM, Fan LM, et al. Socioeconomic disparities in prevalence and behaviors of smoking in rural Southwest China[J]. BMC Public Health, 2019, 19(1): 1117. DOI: 10.1186/S12889-019-7455-0.
[9]	中国肥胖问题工作组. 中国成人超重和肥胖症预防与控制指南(节录)[J]. 营养学报, 2004, 26(1): 1-4. DOI: 10.13325/j.cnki.acta.nutr.sin.2004.01.001. China Obesity Task Group. Guidelines for prevention and control of overweight and obesity in Chinese adults (Excerpt)[J]. Acta Nutrimenta Sinica, 2004, 26(1): 1-4. DOI: 10.13325/j.cnki.acta.nutr.sin.2004.01.001.
[10]	金航, 章文强, 马新雅, 等. 四川省城乡慢性阻塞性肺病患病率及影响因素分析[J]. 预防医学情报杂志, 2021, 37(4): 465-471, 477. https://www.cnki.com.cn/Article/CJFDTOTAL-YFYX202104006.htm Jin H, Zhang WQ, Ma XY, et al. Prevalence and Influencing Factors of Chronic Obstructive Pulmonary Disease in Urban and Rural Areas of Sichuan Province[J]. J Prev Med Inf, 2021, 37(4): 465-471, 477. https://www.cnki.com.cn/Article/CJFDTOTAL-YFYX202104006.htm
[11]	罗倩, 王晓园, 张海涛, 等. 新疆乌鲁木齐市城乡40岁以上居民慢性阻塞性肺疾病的患病情况与相关危险因素分析[J]. 临床肺科杂志, 2019, 24(9): 1562-1567. DOI: 10.3969/j.issn.1009-6663.2019.09.003. Luo Q, Wang XY, Zhang HT, et al. Analysis on the prevalence and risk factors of chronic obstructive pulmonary disease among urban and rural residents over 40 years old in Urumqi Xinjiang[J]. Journal of Clinical Pulmonary Medicine, 2019, 24(9): 1562-1567. DOI: 10.3969/j.issn.1009-6663.2019.09.003.
[12]	黄鑫, 王波. 2019—2020年成都地区慢性阻塞性肺疾病患病特征及影响因素[J]. 公共卫生与预防医学, 2020, 31(5): 68-71. DOI: 10.3969/j.issn.1006-2483.2020.05.018. Huang X, Wang B. Prevalence characteristics and influencing factors of COPD in Chengdu, 2019-2020[J]. J of Pub Heal Prev Med, 2020, 31(5): 68-71. DOI: 10.3969/j.issn.1006-2483.2020.05.018.
[13]	Cockerham WC. Health lifestyle theory and the convergence of agency and structure[J]. J Health Soc Behav, 2005, 46(1): 51-67. DOI: 10.1177/002214650504600105.
[14]	李潇, 蔡乐, 王旭明, 等. 云南省农村老年人五种常见慢性病及共病的流行现状及与社会经济地位的关系[J]. 中华疾病控制杂志, 2019, 23(6): 630-634. DOI: 10.16462/j.cnki.zhjbkz.2019.06.003. Li X, Cai L, Wang XM, et al. The prevalence of five common chronic diseases and multi-morbidity and its relationship with socioeconomic position among rural older adults in Yunnan Province[J]. Chin J Dis Control Prev, 2019, 23(6): 630-634. DOI: 10.16462/j.cnki.zhjbkz.2019.06.003.
[15]	Gershon AS, Warner L, Cascagnette P, et al. Lifetime risk of developing chronic obstructive pulmonary disease: a longitudinal population study[J]. Lancet, 2011, 378(9795): 991-996. DOI: 10.1016/S0140-6736(11)60990-2.
[16]	夏翠翠, 李建新. 社会经济地位对中老年人口慢性疾病患病的影响分析——以心脑血管疾病和慢性呼吸系统疾病为例[J]. 人口学刊, 2018, 40(3): 82-92. DOI: 10.16405/j.cnki.1004-129X.2018.03.008. Xia CC, Lin JX. Influence of socioeconomic status on the middle aged and elderly's chronic non-infectious disease in China: the case of cardiovascular disease and chronic respiratory disease[J]. Popul J, 2018, 40(3): 82-92. DOI: 10.16405/j.cnki.1004-129X.2018.03.008.
[17]	王辰, 肖丹, 池慧. 《中国吸烟危害健康报告2020》概要[J]. 中国循环杂志, 2021, 36(10): 937-952. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGXH202110001.htm Wang C, Xiao D, Chi H. 2020 report on health hazards of smoking in China: an updated summary[J]. Chin Circu J, 2021, 36(10): 937-952. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGXH202110001.htm
[18]	Vorrink SN, Kort HS, Troosters T, et al. Level of daily physical activity in individuals with COPD compared with healthy controls[J]. Respir Res, 2011, 12(1): 33. DOI: 10.1186/1465-9921-12-33.
[19]	Siddharthan T, Grigsby MR, Goodman D, et al. Association between household air pollution exposure and chronic obstructive pulmonary disease outcomes in 13 low- and middle-lncome country settings[J]. Am J Respir Crit Care Med, 2018, 197(5): 611-620. DOI: 10.1164/rccm.201709-1861OC.