中国成年人气流受限与主要慢性病发病风险的前瞻性关联分析

目的 在中国成年人中探究气流受限与主要慢性病发病风险的前瞻性关联。方法 本研究基于中国慢性病前瞻性研究,剔除基线自报患有心脏病、脑卒中和恶性肿瘤的个体后,共纳入基线时30～79岁（平均51.5岁）的研究对象486 996名。分别以慢性阻塞性肺疾病全球倡议（GOLD）标准和第一秒用力呼气容积占预计值百分比（FEV₁%P）评价气流受限,使用Cox比例风险回归模型分析气流受限与缺血性心脏病、脑血管病和肺癌发病之间的关联。结果 在平均7年的随访期间,缺血性心脏病、脑血管病、肺癌分别新发24 644、36 336、3 218例。与气流正常者相比,GOLD-1至GOLD-4人群的缺血性心脏病发病风险比（HR）值（95%CI）依次为0.89（0.78～1.01）、1.05（0.98～1.12）、1.29（1.18～1.40）和1.65（1.42～1.91）;肺癌发病HR值（95%CI）依次为0.96（0.70～1.26）、1.12（0.96～1.31）、1.38（1.14～1.65）和1.48（1.05～2.02）。未发现GOLD分级与脑血管病发病风险之间存在有统计学意义的关联。FEV₁%P每下降10%,缺血性心脏病、脑血管病、肺癌风险分别增加7.2%（95%CI：6.4%～8.0%）、3.6%（95%CI：3.0%～4.3%）、10.5%（95%CI：8.4%～12.6%）。按吸烟状态分层分析,上述结果基本不变。结论 我国成年人群中气流受限程度越严重,个体缺血性心脏病、脑血管病和肺癌的发病风险越高。     

宁夏回族自治区回、汉族居民烟草、酒精使用调查

目的 了解宁夏回族自治区(宁夏)回、汉族居民烟草、酒精使用情况及其分布特征,为民族地区改善戒烟、限酒措施提供参考。方法 采用多阶段系统抽样法,抽取宁夏地区≥18岁居民6 476人进行入户调查。烟草和酒精使用障碍根据国际疾病分类-10(ICD-10)标准采用复合型国际诊断交谈表3.0(CIDI 3.0)中文版评估。结果 共有5 811名受访者完成全部调查,目前吸烟率为19.15%,其中男性吸烟率高于女性(44.73% vs. 1.51%),差异有统计学意义(χ²=1 693.25,P< 0.001);男性中回族吸烟率低于汉族(33.19% vs. 51.95%),差异有统计学意义(χ²=79.99,P< 0.001)。男性烟草依赖患病率为1.75%,回、汉族男性烟草依赖患病率差异无统计学意义(χ²=0.02,P=0.958)。目前饮酒率为5.78%,其中男性饮酒率高于女性(12.48% vs. 1.16%),差异有统计学意义(χ²=329.94,P< 0.001);男性中回族饮酒率低于汉族(4.71% vs. 17.34%),差异有统计学意义(χ²=82.03,P< 0.001);男性酒精使用障碍患病率为6.03%,男性回族酒精使用障碍患病率低于汉族(3.50% vs. 7.61%),差异有统计学意义(χ²=16.68,P< 0.001)。结论 宁夏地区回族成年人烟草和酒精使用率低于同地区汉族,当地的回族文化对减少人群烟草、酒精使用可能具有积极的影响。     

中国慢性病前瞻性研究:10个项目地区成年人群饮茶行为特征差异分析

目的 描述中国慢性病前瞻性研究(CKB)10个项目地区成年人群饮茶行为特征的地区差异。方法 分析CKB 10个项目地区512 891名30～79岁队列成员基线调查时饮茶行为信息,重点描述饮茶者每周饮茶行为特征的地区差异。结果 10个项目地区全部队列成员中,男性每周饮茶率(50.7%)高于女性(21.3%)。其中湖南项目地区调查人群每周饮茶率最高(男性74.3%,女性76.6%),河南项目地区最低(男性5.5%,女性1.0%)。除浙江和海口以外的其他8个项目地区,每周饮茶者以饮绿茶为主。青岛项目地区平均每次(男性3.8 g,女性3.1 g)、每日(男性6.2 g,女性4.1 g)和每周(男性38.4 g,女性25.0 g)茶叶消耗量均最高。结论 CKB 的10个项目地区研究人群在饮茶频率、品种、消耗量和浓淡喜好等特征上均存在较为明显的地区差异。     

北京社区老年人群代谢综合征与慢性肾脏病的关系及性别差异研究

目的 探讨社区老年人群MS与慢性肾脏病(CKD)的关系及其性别差异。方法 2009年9月至2010年6月采用两阶段整群随机抽样, 对北京市万寿路地区≥60岁老年人群进行横断面调查。MS诊断采用2009年国际统一标准定义;CKD诊断采用2012年国际肾脏病组织的标准定义。结果 共纳入2 102名(其中男性848名, 女性1 254名)社区老年人, 年龄60～95(67.9±5.8)岁。MS患病率为59.1%, CKD患病率为12.6%。随着MS组分数目的增加, CKD的患病率从2.9%增加至18.3%(趋势χ²检验P<0.001)。肾功能下降(2.0%增至8.6%)和白蛋白尿(1.9%增至12.1%)同样呈现增加的趋势(趋势χ²检验P<0.001)。多因素分析结果显示, 社区老年人群MS患者患肾功能下降、白蛋白尿、CKD风险是非MS患者的2.13(95%CI:1.39～2.26)倍、1.99(95%CI:1.41～2.82)倍和2.03(95%CI:1.52～2.71)倍。且随着MS组分数目的增加, 患病风险逐渐增加。不同性别比较, 女性人群中MS对肾功能下降(OR:3.30 vs. 1.27)、CKD(OR:2.19 vs. 1.89)患病的影响高于男性, 而对白蛋白尿的影响低于男性(OR:1.22 vs. 2.13)。结论 北京城区的社区老年人群MS与CKD患病风险相关, 且性别对于老年人群MS与CKD的关系有差异。     

慢性阻塞性肺疾病患者体力活动水平及影响因素分析的中英比较研究

目的 比较中英慢性阻塞性肺疾病（COPD）患者体力活动水平及影响因素差异。方法 利用中国慢性病前瞻性研究和英国生物银行基线调查数据,以一秒率（FEV₁/FVC）<70%作为COPD诊断标准,以代谢当量（MET）作为体力活动水平的衡量指标并按性别、年龄分层的MET值三分位数分为低、中、高3级,分别使用多元逐步logistic回归探究体力活动水平与COPD及慢性阻塞性肺疾病全球倡议（GOLD）分级的关系,并进行亚组分析。结果 共纳入506 073名中国成年人和231 884名英国成年人为研究对象。与非COPD人群相比,中英COPD患者低水平体力活动的OR值（95%CI）分别为1.07（1.03~1.10）、1.03（1.01~1.06）;GOLD分级与体力活动水平呈负相关,且在中国人群中存在线性趋势（趋势检验P<0.001）。亚组分析显示,中英人群中高龄、受教育年限少、经济水平低、过去吸烟、有呼吸系统疾病史的COPD患者体力活动水平下降的可能性更大。中国农村COPD患者体力活动下降的可能性更大。结论 COPD与体力活动水平呈负相关,且GOLD分级与体力活动水平呈剂量反应关系,应鼓励和促进COPD患者尤其高危人群多进行体力活动。     

中国慢性病前瞻性研究:10个项目地区成年人超重/肥胖现况分析

目的 描述中国慢性病前瞻性研究(CKB)项目10个地区人群超重/肥胖现状的地区差异。方法 CKB项目于2004－2008年在城市和农村各5个地区募集30～79岁队列成员并完成基线调查,剔除BMI异常个体后,分析10个地区中512 489名队列成员基线调查时的BMI和WC及其对应的超重/肥胖和中心性肥胖分组情况的地区差异。结果 10个地区女性的超重/肥胖(45.3%)和中心性肥胖(44.6%)水平均高于男性(41.7%和38.3%)。青岛项目点人群的超重/肥胖率(男性为66.9%,女性为67.5%)和中心性肥胖率(男性为63.3%,女性为64.9%)均为最高。超重/肥胖的地区差异在男性中更为明显;除河南以外的农村项目点超重/肥胖率相对较低。在BMI< 24.0 kg/m²的非超重/肥胖人群中,部分个体达到中心性肥胖标准(男性为9.8%,女性为15.3%);该比例在青岛项目点更高(男性为22.2%,女性为23.2%)。结论 CKB项目10个地区研究人群的超重/肥胖情况存在明显的地区差异。     

中国10个地区30~79岁成年人被动吸烟行为特征分析

目的 描述中国慢性病前瞻性研究（CKB）项目10个地区非吸烟人群被动吸烟行为特征的地区和人群分布差异。方法 分析10个地区317 486名30~79岁非吸烟者在基线调查时的被动吸烟行为信息,描述其被动吸烟行为特征的地区和人群分布差异。结果 按照全国人口普查结果进行标化,我国成年人被动吸烟率为56.7%,与吸烟者共同居住率为66.5%,其中农村高于城市。周被动吸烟频率、周被动吸烟累计时长、日均被动吸烟时长具有明显的地区差异,城市地区的周被动吸烟累计时长随周被动吸烟频率的增加而增加,女性中湖南省的周被动吸烟频率较高,但周被动吸烟累计时长较低,日均被动吸烟时长最低,河南省却与之相反;与吸烟者共同居住者的被动吸烟率是从未共同居住者的2.27倍（95% CI：2.24~2.29）,且在女性中关联更强（OR=2.61,95% CI：2.58~2.64）,而在男性中二者无关（OR=1.01,95% CI：0.95~1.06）。女性除日均被动吸烟时长小于男性外,其余指标均大于男性;且年龄较小、文化程度较低者的多数被动吸烟指标较高;家庭年收入较低者的被动吸烟率和与吸烟者共同居住率较低,但日均被动吸烟时长较高;女性在婚者的被动吸烟率、与吸烟者共同居住率较高,男性与之相反。结论 CKB项目10个地区非吸烟人群的被动吸烟率、周被动吸烟频率、周被动吸烟累计时长和日均被动吸烟时长以及与吸烟者共同居住率、共同居住年限均存在明显的地区和人群分布差异。     

中国成年人气流受限与慢性病主要死亡风险的前瞻性研究

目的 探讨气流受限与慢性病总死亡和死因别死亡风险间的关联性。方法 基于中国慢性病前瞻性研究项目，剔除基线自报患有心脏病、脑卒中和恶性肿瘤的个体，共纳入基线时项目地区30～79岁的男女性研究对象各199 099和287 895例。气流受限情况采用COPD全球倡议标准（GOLD）判断。使用Cox比例风险回归模型分析气流受限与死亡之间的关联。结果 平均随访7.2年，累计随访3 494 079人年。21 649例在随访期间死亡。气流正常、GOLD-1～GOLD-4等级的全人群粗死亡率（/1 000人年）分别为5.5、9.9、13.1、32.4和63.3。调整可能的混杂因素后，与气流正常人群相比，GOLD-1～GOLD-4的HR值（95% CI）依次为0.98（0.88～1.09）、1.03（0.97～1.09）、1.62（1.53～1.73）和2.83（2.59～3.10）。气流受限等级上升，缺血性心脏病、脑血管病和COPD的死亡风险也上升。结论 存在气流受限或气流受限程度越严重，个体发生死亡的风险越高。     

中国10个地区人群高血压患病率、知晓率、治疗率和控制情况分析

目的 描述中国慢性病前瞻性研究(CKB)队列的10个地区人群中高血压的患病、知晓、治疗和控制现状及其地区差异。方法 CKB项目于2004-2008年在10个项目地区募集512891名30~79岁队列成员并完成基线调查。本研究利用CKB项目的基线信息,比较对年龄和/或性别进行调整后高血压患病率、知晓率、治疗率及其控制情况的地区差异。结果 10个项目地区中,高血压患者共180621人(35.2%),其中浙江项目地区患病率最高(44.4%),海口项目地区患病率最低(22.0%)。农村地区人群患病率(35.1%)高于城市(32.1%),差异有统计学意义(P<0.001)。在高血压人群中,知晓率为33.1%(59703/180621),治疗率为36.1%(65172/180621),控制率为12.4%(22329/180621),服用降压药物的人群中控制率为30.5%(19884/65172),其中苏州项目地区的男性控制率(17.4%)和服药控制率(39.1%)高于其他地区,柳州项目地区的女性控制率(23.5%)和服药控制率(42.6%)高于其他地区。结论 CKB项目10个地区人群中高血压患病率较高,知晓率、治疗率和控制率偏低,研究人群的高血压患病、知晓、治疗和控制情况存在明显地区差异。     

2014－2015年中国40岁及以上慢性阻塞性肺疾病患者肺功能检查率及其影响因素分析

目的 了解2014-2015年我国≥ 40岁慢性阻塞性肺疾病（慢阻肺）患者的肺功能检查率及其影响因素,为慢阻肺患者规范化诊断、治疗和管理提供依据。方法 数据来源于2014-2015年中国居民慢阻肺监测。采用面对面调查的方法收集调查对象既往肺功能检查状况等信息。通过肺功能检查将吸入支气管舒张剂后FEV₁/FVC<70%者诊断为慢阻肺患者,共纳入9 130名慢阻肺患者。经复杂抽样加权后,估计≥ 40岁慢阻肺患者肺功能检查率及其95% CI,并分析其影响因素。结果 我国≥ 40岁慢阻肺患者肺功能检查率为5.9%（95% CI：4.9%~6.9%）,男性为6.1%（95% CI：5.2%~7.1%）,女性为5.3%（95% CI：4.0%~6.6%）,城镇高于乡村（P<0.001）,且随患者文化程度升高而增加（P<0.001）。务农慢阻肺患者肺功能检查率最低为4.0%（95% CI：3.1%~4.9%）。知晓肺功能检查的患者肺功能检查率为32.3%（95% CI：26.4%~38.1%）。有既往慢性呼吸系统疾病史和有呼吸道症状的患者肺功能检查率分别为13.7%（95% CI：11.5%~15.9%）和8.8%（95% CI：7.2%~10.4%）。有职业粉尘和/或有害气体暴露的慢阻肺患者肺功能检查率为5.7%（95% CI：4.6%~6.9%）。曾经吸烟的患者肺功能检查率为10.2%（95% CI：8.0%~12.4%）,均高于现在吸烟者（4.2%,95% CI：3.3%~5.1%）和从不吸烟者（6.3%,95% CI：5.1%~7.6%）。结论 我国≥ 40岁慢阻肺患者肺功能检查水平很低,慢阻肺患者规范化诊断、治疗和管理水平亟待提高。     

Self‐reported physician‐diagnosed chronic obstructive pulmonary disease and spirometry patterns in Vietnam Era US Army Chemical Corps veterans: A retrospective cohort study

Background

Research on chronic obstructive pulmonary disease (COPD) and herbicide exposure in Vietnam War veterans is limited.

Methods

Survey data were collected from 3193 US Army Chemical Corps veterans on herbicide exposure and self‐reported physician‐diagnosed COPD. Three spirometric patterns were used to define airflow obstruction (AFO): (i) FEV₁/FVC < 70% (“fixed ratio”); (ii) FEV₁/FVC < lower limit of normal (“LLN”); and (iii) (FEV₁/FVC < LLN and FVC ≥ LLN and FEV₁1/FVC1 ≥ LLN) (“specific obstruction”). Associations between herbicide exposure and self‐reported COPD and spirometric‐AFO were determined using regression.

Results

COPD prevalence varied (self‐reports: 20.1%; spirometry: 29.8%, 12.9%, 8.4% by fixed ratio, LLN, and specific obstruction definitions, respectively). Spirometric parameters did not differ by exposure. Self‐reported COPD and herbicide exposure were significantly associated (adjusted odds ratio [aOR] = 1.82, 95% confidence intervaI: 1.48,2.24). No association was found between spirometric‐AFO and herbicide exposure.

Conclusions

A significant association was found between herbicide exposure and self‐reported physician‐diagnosed COPD but not when COPD diagnosis was based on spirometry.

     

The impact of adiposity indices on lung function in children with respiratory allergic diseases

IntroductionThe effect of obesity on lung function in children stratified by asthma status is not fully elucidated. We evaluated the impact of adiposity indices, including Body Mass Index (BMI) and estimated fat mass (eFT), on lung changes in asthmatic and non-asthmatic children with rhinitis.Patients and MethodsWe performed a retrospective review of 400 pediatric patients, classified into an asthma group (n = 200) and a no-asthma group (n = 200). According to the BMI z-score all subjects were classified into normal-weight patients (NW; ?2 ≤ BMI z-score <1) and overweight patients/patients with obesity (OW/OB; BMI z-score ≥1). Lung function parameters were measured by spirometry. BMI and eFM were considered as adiposity indices.ResultsExcess weight/obesity was present in 37 % of patients. The OW/OB group showed higher basal forced expiratory vital capacity (FVC) and lower forced expiratory volume in 1 s (FEV₁), FEV₁/FVC ratio compared to the NW group (p ≤ 0.01). FVC and FEV₁ were correlated with the BMI z-score, and FEV₁/FVC with eFT (p ≤ 0.01). No differences were noted between the NW and the OW/OB groups in terms of respiratory parameters except for FVC (p < 0.01). In the OW/OB group, asthma patients were significantly different based on FEV₁, FEV₁/FVC, and forced expiratory flow at 25–75 % of FVC (FEF_25/75) (p < 0.01). The BMI z-score was correlated with FVC and FEV₁ in both the no-asthma and asthma groups (p ≤ 0.01 and p ≤ 0.05, respectively), while eFM was correlated with FEV₁/FVC (p = 0.007) in the asthma group only.ConclusionObesity seems to have a significant impact on lung function in children with respiratory allergic diseases. BMI and eFM may be used to evaluate the impact of adiposity on lung function.     

Cross-Sectional Study on the Association between Pulmonary Function and Sarcopenia in Brazilian Community-Dwelling Elderly from the Amazon Region

Objectives

To compare the obtained and expected values of pulmonary function variables between sarcopenic and non-sarcopenic elderly; verify the association between the pulmonary function and the indicators and diagnosis of sarcopenia; and establish cut-off points for pulmonary function variables to predict sarcopenia.

Design

Cross-sectional study.

Location

Macapá, Brazil.

Participants

community-dwelling elderly ≥ 60 years old (n=383), both sexes.

Measures

Were evaluated according to variables of pulmonary function (spirometry) and sarcopenia, according to the EWGSOP consensus. The association between pulmonary function and sarcopenia was performed using logistic regression and cut-off points established from the ROC Curve.

Results

The prevalence of sarcopenia was 12.53% (n = 48). Sarcopenic individuals had significantly lower mean values for FVC, FEV₁, FEF_25–75% and PEF than non-sarcopenic. After adjustment, spirometric variables were inversely associated with sarcopenia (the increase by one unit of liter in FVC, FEV₁ and FEF_25–75% decreased the probability of sarcopenia by 59%, 67% and 39%, respectively), and the majority of these variables with the muscular strength indicator. Cut-off points, for elderly men and women, were discriminant criteria for the presence of sarcopenia: FVC (≤2.52 L and ≤1.82 L), FEV₁ (≤2.1 L and ≤1.39 L), PEF (≤3.45 L/s and ≤2.93 L/s) and FEF_5–75% (≤1.97 L/s and ≤1.74 L/s).

Conclusions

There was loss of pulmonary function in sarcopenic elderly patients and an inverse association with the diagnosis of sarcopenia and its indicators. Cut-off points of pulmonary function variables can be used as a useful tool to discriminate sarcopenia.

     

Spirometric “abnormality” in a normal male reference population: Further analysis of the 1971 oregon survey

Conventional criteria for spirometric impairment (FVC and FEV₁ ? 79% predicted, FEF_25-75 ? 74% predicted, FEV₁/FVC ? 0.69 for most ages) were applied to 507 healthy nonsmoking male subjects in the 1971 Oregon survey. Frequency of air flow impairment was higher than expected for a normal population. Of all subjects, 17.8% had an “abnormal” FEF_25-75% and 19.7% an “abnormal” FEV₁/FVC. “Decreased” lung volumes were seen in older subjects; of those over 55 years of age, 8.8% had a reduced FVC and 11.8% a reduced FEV₁. These rates in a normal population may be used as a rough baseline for making inferences about a population under study. Similar rates were found in a cross-sectional survey of nonsmoking males representative of the population of a large industrial state. The major reason for these high rates of “abnormal” spirometry lies in the conventional definitions of abnormality. Tables showing cut-off points for abnormal spirometric values based on a 95% confidence interval for adult males of all ages and heights permit an alternative method for classification as abnormal.     

Combined effect of lung function level and decline increases morbidity and mortality risks

Lung function level and decline are each predictive of morbidity and mortality. Evaluation of the combined effect of these measurements may help further identify high-risk groups. Using Copenhagen City Heart Study longitudinal spirometry data (n = 10,457), 16–21 year risks of chronic obstructive pulmonary disease (COPD) morbidity, COPD or coronary heart disease mortality, and all-cause mortality were estimated from combined effects of level and decline in forced expiratory volume in one second (FEV₁). Risks were evaluated using Cox proportional hazards models for individuals grouped by combinations of baseline predicted FEV₁ and quartiles of slope. Hazard ratios (HR) and 95 % confidence intervals (CI) were estimated using stratified analysis by gender, smoking status, and baseline age (≤45 and >45). For COPD morbidity, quartiles of increasing FEV₁ decline increased HRs (95 % CI) for individuals with FEV₁ at or above the lower limit of normal (LLN) but below 100 % predicted, reaching 5.11 (2.58–10.13) for males, 11.63 (4.75–28.46) for females, and 3.09 (0.88–10.86) for never smokers in the quartile of steepest decline. Significant increasing trends were also observed for mortality and in individuals with a baseline age ≤45. Groups with ‘normal’ lung function (FEV₁ at or above the LLN) but excessive declines (fourth quartile of FEV₁ slope) had significantly increased mortality risks, including never smokers and individuals with a baseline age ≤45.