吸烟对四川省30岁及以上居民慢性阻塞性肺疾病发病风险影响的前瞻性研究

魏港吉; 陈晓芳; 陈小芳; 伍霞; 常晓宇; 裴培; 吴先萍

Abstract

魏港吉,陈晓芳,陈小芳,伍霞,常晓宇,裴培,吴先萍.吸烟对四川省30岁及以上居民慢性阻塞性肺疾病发病风险影响的前瞻性研究[J].Chinese journal of Epidemiology,2023,44(5):778-785

吸烟对四川省30岁及以上居民慢性阻塞性肺疾病发病风险影响的前瞻性研究

Relationship between smoking and the risk of morbidity of chronic obstructive pulmonary diseases among residents aged 30 years and above in Sichuan Province: a prospective study

Received:November 23, 2022

DOI：10.3760/cma.j.cn112338-20221123-00994

KeyWord: 慢性阻塞性肺疾病吸烟发病风险

English Key Word: Chronic obstructive pulmonary disease Smoking Risk of morbidity

FundProject:国家自然科学基金(82192900,82192901,82192904);国家重点研发计划"精准医学研究"重点专项(2016YFC0900500,2016YFC0900501);中国香港Kadoorie Charitable基金;英国Wellcome Trust(212946/Z/18/Z,202922/Z/16/Z,104085/Z/14/Z,088158/Z/09/Z)

Author Name	Affiliation	E-mail
Wei Gangji	School of Public Health, Chengdu Medical College, Chengdu 610500, China
Chen Xiaofang	School of Public Health, Chengdu Medical College, Chengdu 610500, China	85456075@163.com
Chen Xiaofang	Pengzhou Center for Disease Control and Prevention, Sichuan Province, Pengzhou 611930, China
Wu Xia	Pengzhou Center for Disease Control and Prevention, Sichuan Province, Pengzhou 611930, China
Chang Xiaoyu	Sichuan Provincial Center for Disease Control and Prevention, Chengdu 610041, China
Pei Pei	Peking University Center for Public Health and Epidemic Preparedness& Response, Beijing 100191, China
Wu Xianping	Sichuan Provincial Center for Disease Control and Prevention, Chengdu 610041, China

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Abstract:

目的了解四川省≥30岁居民慢性阻塞性肺疾病（COPD）的发病情况，分析吸烟对COPD发病风险的影响。方法 2004-2008年随机抽取四川省彭州市30~79岁人群进行问卷调查、体格检查和肺功能检测，并进行长期随访，确定COPD发病情况。运用Cox比例风险回归模型分析吸烟与COPD的关系。结果共纳入46 540名研究对象，男性当前吸烟占比为67.31%，女性为8.67%，有3 101名新发COPD，累积发病率为6.66%。控制年龄、性别、职业、婚姻状况、家庭年收入、文化程度、BMI、日均总体力活动水平、当前做饭频率、当前有无排烟装置、被动吸烟暴露频率等因素后，多因素Cox比例风险回归分析显示，与从不吸烟人群相比，当前吸烟、戒烟增加COPD的发病风险，HR值分别为1.42（95%CI：1.29~1.57）和1.34（95%CI：1.16~1.53）。与从不或偶尔吸烟人群相比，日均吸烟量越大，COPD发病风险越高；当前吸烟类型为混吸、开始吸烟类型为混吸增加COPD的发病风险，HR值分别为1.79（95%CI：1.42~2.25）和2.12（95%CI：1.53~2.92）；开始吸烟年龄<18、≥18岁增加COPD的发病风险，HR值分别为1.61（95%CI：1.43~1.82）和1.34（95%CI：1.22~1.48）；吸烟时吸入口腔后即吐出、吸到咽喉部和深吸到肺部增加COPD的发病风险，HR值分别为1.30（95%CI：1.16~1.45）、1.63（95%CI：1.45~1.83）和1.37（95%CI：1.21~1.55）。控制多个混杂因素，校正回归稀释偏倚后，日均吸烟量、开始吸烟年龄和烟吸入部位对COPD发病均有影响，性别差异尤为突出。结论吸烟增加COPD的发病风险，这种影响与吸烟量、吸烟类型、开始吸烟年龄和烟吸入部位等存在一定关系，控烟应综合考虑吸烟的具体特征，从而预防COPD的发生。

English Abstract:

Objective To investigate the morbidity of chronic obstructive pulmonary diseases (COPD) in residents aged 30 years and above in Sichuan Province, and analyze the effect of smoking on the risk of morbidity on COPD. Methods From 2004 to 2008, people were randomly selected from Pengzhou, Sichuan Province. All the local people aged 30-79 years were asked to receive questionnaire survey, physical examination and pulmonary function testing, and long-term follow-up to determine the morbidity of COPD. Cox proportional hazard regression model was used to analyze the relationship between smoking and COPD. Results In 46 540 participants, the current smoking rates were 67.31% in males and 8.67% in females, there were 3 101 new cases of COPD, with a cumulative incidence of 6.66%. Adjusted for age, gender, occupation, marriage, income level, educational level, BMI, daily total physical activity, current cooking frequency, whether there was smoke exhaust device at present and frequency of passive smoking exposure, multivariate Cox proportional hazard regression analysis showed that compared with the non-smoking population, current smoking and quitting smoking increased the risk of COPD, with HR of 1.42 (95%CI:1.29-1.57) and 1.34 (95%CI:1.16-1.53). Compared with people who never or occasionally smoke, the risk of morbidity on COPD increased with the increase of average daily smoking volume, mixed smoking at present, mixed smoking at the beginning increased the risk of COPD, with HR of 1.79 (95%CI: 1.42-2.25) and 2.12 (95%CI: 1.53-2.92), started smoking at the age of <18 years old and ≥18 years old increased the risk of COPD, with HR of 1.61 (95%CI:1.43-1.82) and 1.34 (95%CI: 1.22-1.48), inhaling into the mouth, throat and lung during smoking increased the risk of COPD, with HR of 1.30 (95%CI: 1.16-1.45), 1.63 (95%CI: 1.45-1.83) and 1.37 (95%CI: 1.21-1.55). Adjusted for multiple confounding factors and adjusted for regression dilution bias, the average daily smoking volume, the age of starting smoking and the depth of smoking inhalation had an impact on the incidence of COPD, and the gender difference was particularly prominent. Conclusions Smoking increased the risk of morbidity on COPD, which was related to the average daily smoking volume, the type of smoking, the age of starting smoking and the depth of smoking inhalation. Tobacco control should comprehensively consider the specific characteristics of smoking, so as to prevent COPD.

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