社区综合干预对北京市郊区吸烟、慢性支气管炎和哮喘流行的影响

目的研究社区综合干预对北京市郊区人群吸烟、慢性支气管炎和哮喘流行情况的影响.方法1992年,将北京市房山区23个自然村整群随机分为13个干预村和10个对照村,对干预村进行以戒烟、改善居住环境为主的社区人群综合干预,对照村未施加干预.2000年4月,对干预区和对照区34 436名15岁以上人群进行吸烟、慢性支气管炎和哮喘流行情况普查.同期,对1 658名慢性阻塞性肺疾病(COPD)高危人群进行卫生知识水平、居住环境和吸烟状况的基线调查和复查.结果干预区男女高危人群卫生知识水平得分改善幅度和居住环境好转率显著大于对照区(P＜0.001).干预区全人群中男性吸烟率、现吸烟率下降幅度显著大于对照区(0.4% vs -0.8%,P＜0,001;2.4% vs 1.3%,P＜0.001),女性差异无显著性(P＞0.05).无论男女,干预区15～24岁人群1993～2000年累积新吸烟率显著低于对照区(男:18.9% vs 23.7%,P=0.005;女:0% vs 0.7%,P=0.005).干预区吸烟者日吸烟支数低于对照区男:(14.8±7.0)支/d vs(17.2±8.2)支/d,P＜0.001;女:(12.8±6.9)支/d vs(13.4±7.2)支/d,P=0.088].由于人群老龄化,慢性支气管炎患病率呈上升趋势,干预村上升幅度低于对照村(男:0.9% vs 1.3%,P=0.012;女:0.1% vs 0.3%,P=0.003).控制年龄因素后,干预村慢性支气管炎1993～2000年累积发病率低于对照村(比值比:男性为0.80,95%CI:0.60～1.07;女性为0.76,95%CI:0.45～1.28).干预区男女哮喘患病率和累积发病率均与对照区差异无显著性(P＞0.05).结论社区综合干预可以有效提高人群COPD防治知识水平,改善居住环境,降低人群新发吸烟率和吸烟量,减少慢性支气管炎的发生,对哮喘无明显影响.

Effects of comprehensive interventions in community on smoking, chronic bronchitis, and asthma in rural areas of Beijing

OBJECTIVE: To study the effects of comprehensive interventions in community on smoking, chronic bronchitis, and asthma in rural areas of Beijing. METHODS: Twenty-three villages in rural areas of Beijing were randomly divided into interventional (13 villages) and control villages (10 villages) in 1992. Comprehensive interventions including education of former-smokers and improvement of living environment were carried out in the interventional villages, and none was done in the control villages. In April 2000, surveys on smoking, chronic bronchitis, and asthma were carried out among 34,436 participants aged 15 or more in the interventional and control villages. During the same period, knowledge on prevention from chronic obstructive pulmonary diseases (COPD), living environments, and smoking were assessed among 1658 high-risk individuals of COPD at baseline and following-up period. RESULTS: The scores of knowledge and improvement on living environments in the interventional villages were significantly higher than those in control villages (P < 0.001). The decrease rate of smoking and current smoking rate in the interventional villages were significantly higher than in the control villages (0.4% vs -0.8%, P < 0.001; 2.4% vs 1.3%, P < 0.001) in men, while not different in women (P > 0.05). Among never smokers at baseline, the accumulated incidence of smoking among people aged 15 to 24 from 1993 to 2000 was significantly lower in the interventional villages than in the control villages in men (18.9% vs 23.7%, P = 0.005) and in women (0% vs 0.7%, P = 0.005). Daily cigarettes smoked by smokers in the interventional villages were less than in control villages in both men (14.8 +/- 7.0 vs 17.2 +/- 8.2 cigs daily, P < 0.001) and women (12.8 +/- 6.9 vs 13.4 +/- 7.2 cigs daily, P = 0.088). The increase of prevalence of chronic bronchitis in the interventional villages was less than in the control villages (men: 0.9% vs 1.3%, P = 0.012; women: 0.1% vs 0.3%, P = 0.003). After the age factor is adjusted, odds ratio (OR) for accumulated incidence of chronic bronchitis from 1993 to 2000 in the interventional villages were 0.80 (95%CI: 0.60-1.07) for men, 0.76 (95%CI: 0.45-1.28) in women. The OR for asthma was not significant in both men and women. CONCLUSIONS: Comprehensive interventions in community may improve knowledge of COPD prevention and living environments, decrease the smoking rate, cigarettes smoked per day, and incidence of chronic bronchitis, but have no significant effects on asthma.