上海市成人慢性阻塞性肺疾病患病率和危险因素分析

Prevalence and risk factors of adult chronic obstructive pulmonary disease in Shanghai

目的调查2012—2013年上海市20岁及以上人群COPD的患病率,评估上海市的COPD流行现状,分析COPD相关危险因素,为制订防治策略提供依据。方法于2012—2013年采用多阶段分层随机抽样的方法,选择上海市的4个区,每个区抽取2个城市社区或乡村社区,1个家庭选取1名志愿者进行问卷调查、身体测量和肺功能检查。以支气管扩张试验后FEV 1/FVC<70%作为COPD的定义,分析COPD的年龄标化患病率及其危险因素。结果共选取志愿者5281名(男2214名、女3067名)参与调查,排除无效数据后,最终统计分析了5275例受试者数据。2012—2013年上海市20岁及以上人群的COPD年龄标化患病率为6.8%(95%CI:6.1%~7.4%),男性患病率(9.4%)显著高于女性(4.7%,P<0.001)。COPD患病率随年龄增长呈上升趋势(P<0.001),40岁及以上人群年龄标化患病率达11.5%,60岁及以上人群年龄标化患病率达21.2%。现吸烟人群年龄标化患病率(10.1%)显著高于不吸烟人群(5.5%,OR=1.54,P<0.001)。男性教育水平与COPD患病率呈负相关,小学及以下学历的男性患病率显著高于初、高中,大学及以上(整体人群P=0.043,不吸烟人群P=0.020)。有哮喘病史人群COPD患病率(23.4%)显著高于无病史人群(6.4%,OR=6.93,P<0.001)。有儿童时期肺炎或支气管炎病史人群COPD患病率(12.0%)显著高于无病史人群(6.6%,OR=2.43,P=0.004)。仅9.3%的COPD患者曾行肺功能检查,仅4.0%的患者曾被临床诊断为COPD。结论2012—2013年上海市40岁及以上人群COPD患病率高,男性、高龄、吸烟史、儿童时期肺炎或支气管炎病史是COPD的主要危险因素。哮喘与COPD患病风险有关,临床医师诊断时需提高对两病重叠的警惕性。戒烟宣传教育和推广高危人群的肺功能检查筛查亟待加强,以提高COPD的诊断和治疗率,改善患者预后。

Objective To investigate the prevalence and risk factors of chronic obstructive pulmonary disease(COPD)among people aged 20 years and over in Shanghai from 2012 to 2013.Methods A multistage stratified random sampling was used in this study,and participants selected from 4 districts in Shanghai(2 urban communities and 2 rural communities from each districts,with one volunteer from each family)took questionnaire survey,physical examination and lung function test.FEV 1/FVC<70% after bronchodilatation test was defined as COPD.Prevalence and risk factors associated with COPD among the participants were analyzed.Results A total of 5281 volunteers(2214 males and 3067 females)participated in this study.After excluding invalid data,clinical data from 5275 people were analyzed.The standardized prevalence of COPD in this study was 6.8%(95%CI:6.1%-7.4%).The prevalence rate was higher in men than in women(9.4%vs.4.7%,P<0.001).The prevalence rate increased with age(P<0.001),11.5% in people aged ≥40 years and 21.2%in people aged≥60 years.The prevalence of COPD among current smokers was higher than that among nonsmokers(10.1%vs.5.5%,OR=1.54,P<0.001).Male education level was negatively correlated with the prevalence of COPD,and the prevalence in men with primary school education was significantly higher than that in men with middle school,college and higher education levels(in general population P=0.043,in non-smokers P=0.020).The prevalence of COPD among people with asthma history was higher than those without the history(23.4%vs.6.4%,OR=6.93,P<0.001).The prevalence of COPD among people with pneumonia or bronchitis in childhood were significantly higher than those without the history(12.0%vs.6.6%,OR=2.43,P=0.004).Only 9.3% of COPD people reported a previous pulmonary function test,and 4.0% patients had been diagnosed with COPD.Conclusion There is a high prevalence of COPD among people aged 40 and older in Shanghai between 2012 and 2013.Male,advanced age,history of smoking,and history of childhood pneumonia or bronchitis are main risk factors of COPD.Clinicians need more awareness of asthma-COPD overlap due to the correlation between asthma and COPD.Therefore,it is necessary promote smoking cessation and lung function screening in high-risk population to achieve early detection,diagnosis and treatment.