2016—2019年慈溪地区40岁以上人群呼吸系统疾病死亡与烟草暴露的相关性分析

目的定量研究人群呼吸系统疾病死亡与烟草暴露的相关性,为烟草防控工作提供科学依据。方法以2015年慢性病及其危险因素监测数据库作为基线资料,主动随访2016—2019年浙江慈溪地区40岁以上人群呼吸系统疾病情况以及相关基本信息,采用归因分析和Cox比例风险模型统计学方法进行相关性分析,得到烟草暴露人群的归因危险度百分比(population attributable risk percent,PAR%)以及死亡风险比(hazard ratio,HR)。结果2016—2019年浙江慈溪地区呼吸系统疾病的总死亡率为117.96/10万,男性为148.86/10万,高于女性死亡率87.07/10万,差异有统计学意义(P=0.015);呼吸系统疾病中慢性阻塞性肺疾病(chronic obstructive pulmonary diseases,COPD)的PAR%(69.48%),高于其他慢性呼吸系统疾病;COPD和下呼吸道感染的死亡与烟草暴露呈正相关(P<0.05),年龄段50~59岁组,吸烟指数每增加10年支患COPD死亡风险增加13%(HR=1.13,95%CI:1.08~1.24),下呼吸道感染的死亡风险增加20%(HR=1.20,95%CI:1.03~1.23)。结论吸烟作为呼吸系统疾病负担的主要危险因素之一,烟草暴露与呼吸系统疾病死亡具有明确的相关性,COPD的归因危险度百分比最高,应该引起足够的关注;不同性别、年龄人群对烟草危害的敏感性不同,应有针对性的进行控烟工作。

Correlation between deaths from respiratory diseases and tobacco exposure in people over 40 years old in Cixi region,2016-2019

Objective To quantitatively study the correlation between deaths due to respiratory diseases and tobacco exposure in population so as to provide a scientific basis for tobacco prevention and control.Methods Data from the database concerning monitoring of chronic diseases and their risk factors in 2015 were used as the baseline data.We actively performed follow-up of respiratory diseases and related general information among people over 40 years old in Cixi region,Zhejiang Province from 2016 to 2019.Attribution analysis and Cox proportional hazard model were used for statistical correlation analysis,and the population attributable risk percent(PAR%)and the hazard ratio(HR)of the tobacco-exposed population were obtained.Results From 2016 to 2019,the total mortality rate of respiratory diseases in Cixi,Zhejiang was 117.96/100,000,and the mortality rate was higher in males(148.86/100,000)than in females(87.07/100,000),showing a statistically significant difference(P=0.015).Among the diseases of respiratory system,PAR%of chronic obstructive pulmonary diseases(COPD)was 69.48% which was higher than those of other chronic respiratory diseases.The deaths from COPD and lower respiratory infections were positively correlated with tobacco exposure(P<0.05).Among the group aged 50-59 years,the risk of death in COPD increased by 13% for each 10-year increase in smoking index(HR=1.13,95%CI:1.08-1.24),and the risk of death in lower respiratory infections increased by 20%(HR=1.20,95%CI:1.03-1.23).Conclusions Smoking is one of the main risk factors for the burden of respiratory diseases.Tobacco exposure has a clear correlation with death from respiratory diseases.The attributable risk percentage of COPD is the highest and should be given sufficient attention.The sensitivities of hazards from tobacco exposure among different gender and age populations are dissimilar;and hence,tobacco control work should be targeted.