六个国家室内空气污染和吸烟对≥50岁人群哮喘的交互作用研究

Interaction between indoor air pollution and smoking on senile asthma in six countries

目的探讨室内空气污染和吸烟之间的交互作用对≥50岁人群哮喘的影响,为哮喘的防控提供科学依据。方法随机抽取中国、加纳、印度、墨西哥、俄罗斯和南非6个中低收入国家的居民家庭户进行家庭问卷调查和对所有≥50岁的成员进行个人问卷调查。运用logistic回归模型分别分析室内空气污染(做饭燃料、烟囱设施)和吸烟(是否吸烟、吸烟频率、烟龄)与人群哮喘患病的关系,利用乘法模型和加法模型评价空气污染和吸烟对人群哮喘的交互作用影响。结果共有33 327名调查对象纳入分析,≥50岁人群哮喘的总患病率为3.89%(1 296/33 327)。调整国家、年龄、性别、婚姻状况、居住地、教育程度、体力活动、家庭收入等混杂因素后,吸烟人群相对于从不吸烟人群患哮喘风险增加(OR=1.18,95%CI:1.01～1.45);在不同吸烟频率的人群中,偶尔吸烟人群患哮喘的风险最高(OR=1.75,95%CI:1.33～2.30)。交互作用分析结果显示,除烟龄和做饭燃料外,室内空气污染和吸烟之间对≥50岁人群哮喘存在相加交互作用;是否吸烟(交互项OR=1.60,95%CI:1.26～2.02)、吸烟频率(交互项OR=1.61,95%CI:1.28～2.04)、吸烟烟龄(交互项OR=1.69,95%CI:1.39～2.21)均与做饭燃料之间在≥50岁人群哮喘患病风险中存在相乘交互作用。当2种危险因素同时存在时,患哮喘的风险最高。吸烟和做饭燃料为柴/煤/炭人群患哮喘的风险是不吸烟和燃料为电/燃气的1.43倍(95%CI:1.17～1.75)。结论室内空气污染和吸烟均与≥50岁人群哮喘患病有关,并对≥50岁人群哮喘患病存在交互作用。

Objective To investigate the effect of interaction between indoor air pollution and smoking on senile asthma.Methods Households in six low-and middle-income countries:China,Ghana,India,Mexico,Russia,and South Africa,were randomly selected for household surveys,and individual questionnaires were conducted among all members aged 50 years and older.Logistic regression models were used to analyze the relationship between indoor air pollution(cooking fuel,chimney facilities),smoking(smoking status,smoking frequency,smoking duration),and senile asthma.Multiplication and addition models were used to assess the effects of interaction between air pollution and smoking on senile asthma.Results A total of 33 327 respondents were included in the analysis,and the overall prevalence of senile asthma in six countries was 3.89%(1 296/33 327).After adjusting for confounding factors of country,age,gender,marital status,place of residence,education level,physical activity,and family income,the risk of asthma increased among smokers compared with that of non-smokers(OR=1.18,95%CI:1.01-1.45);among the participants with different smoking frequencies,those who smoked occasionally had the highest risk of asthma(OR=1.75,95%CI:1.33-2.30).The interaction analysis showed that besides smoking duration and cooking fuel,there was additive interaction between indoor air pollution and smoking on senile asthma;multiplier interactions between smoking status(interaction OR=1.60,95%CI:1.26-2.02),smoking frequency(interaction OR=1.61,95%CI:1.28-2.04),smoking duration(interaction OR=1.69,95%CI:1.39-2.21)and cooking fuel were found to be correlated with the risk of asthma in the elderly.The risk of asthma was highest when two risk factors coexisted.The risk of asthma in smokers using firewood/coal/charcoal as cooking fuel was 1.43 times higher than that of non-smokers using the electricity/gas as cooking fuel(95%CI:1.17-1.75).Conclusion Both indoor air pollution and smoking were associated and interacted with senile asthma.