云南省纳西族居民烟草暴露相关慢性阻塞性肺疾病的经济负担研究

Economic Burden of Chronic Obstructive Pulmonary Disease Induced by Tobacco Smoke Exposure in Yunnan Naxi People

背景慢性阻塞性肺疾病(COPD)现已成为一个重要的公共卫生问题,其患病率较高,治疗费用高昂,因COPD带来的疾病经济负担较重。目的对云南省纳西族居民归因于吸烟和被动吸烟的COPD经济负担进行分析。方法于2018年7—8月,运用多阶段分层随机抽样的方法,在云南省丽江市玉龙纳西族自治县抽取年龄≥35岁的纳西族居民进行问卷调查及肺功能检查。测算人均直接疾病经济负担、人均间接疾病经济负担、COPD患者的总经济负担、归因于吸烟/被动吸烟的经济负担。结果共发放问卷2 600份,回收有效问卷2 531份,有效回收率为97.35%。云南省纳西族居民COPD的患病率为17.66%,吸烟率为40.58%,被动吸烟率为38.29%;其中男性吸烟率高于女性(P<0.001);女性被动吸烟率高于男性(P<0.001)。吸烟者〔OR=1.903,95%CI(1.507,2.404)〕和被动吸烟者〔OR=2.195,95%CI(1.718,2.805)〕患COPD的可能性高于非吸烟者和非被动吸烟者。云南省纳西族COPD患者的人均直接疾病经济负担、间接疾病经济负担和疾病经济负担分别为2 827.82元、105.00元和2 932.82元,总疾病经济负担为6 407万元;其中归因于吸烟、被动吸烟的经济负担分别为1 718万元、2 011万元;男性归因于被动吸烟的经济负担低于吸烟,而女性则相反。结论吸烟和被动吸烟给当地带来了沉重的疾病经济负担。加大控烟力度、降低吸烟率和被动吸烟率,有助于减轻COPD的经济负担。

Background Chronic obstructive pulmonary disease (COPD) has become a major public health problem due to its high prevalence,cost of treatment,and economic burden of conditions associated with COPD.Objective To analyze the economic burden of COPD attributed to active and passive smoking exposure among the Naxi People in Yunnan province.Methods From July to August 2018,a questionnaire survey and lung function tests were conducted with the Naxi People(≥35 years old) selected from Yunnan’s Yulong County by use of multi-stage stratified random sampling.Per capita direct and indirect economic burden of COPD,total economic burden of COPD,and the economic burden attributable to active/passive smoking were estimated.Results Altogether,2 600 cases participated in the survey,and 2 531 of them(97.35%) who completed the survey effectively were finally included.The prevalence of COPD,smoking,and passive smoking among the participants was 17.66%,40.58%,and 38.29%,respectively.Men had obviously higher prevalence of active smoking and notable lower prevalence of passive smoking than women (P<0.001).Active smokers〔OR=1.903,95%CI(1.507,2.404)〕had a higher likelihood of developing COPD than non-smokers.Passive smokers〔OR=2.195,95%CI(1.718,2.805)〕had a higher likelihood of developing COPD than non-passive smokers.The per capita direct,indirect and economic burden of COPD for the COPD participants was 2 827.82 yuan,105.00 yuan and 2 932.82 yuan,respectively,and the total economic burden of COPD was 64.07 million yuan.The economic burden of COPD attributable to active and passive smoking was 17.18 million yuan and 20.11 million yuan,respectively.Passive smoking contributed less to economic burden of COPD than active smoking in men,while for women the opposite was true.Conclusion Active and passive smoking may produce substantial economic burden of COPD in the Naxi people,which might be reduced by reducing the smoking prevalence via increasing tobacco control efforts.