"中国县域慢阻肺管理中心"项目慢性阻塞性肺疾病高危人群筛查及危险因素分析

Screening and risk factor analysis of high-risk groups of chronic obstructive pulmonary disease under the"China County COPD Standardization Management Center"project

目的分析"中国县域慢阻肺管理中心"(简称"4C中心")项目慢性阻塞性肺疾病(简称慢阻肺)高危人群比例及危险因素。方法本研究为横断面研究。采用随机整群抽样法。2016年1月至2021年10月在"4C中心"项目下六大区域(东北、华东、华北、华中、西北、西南)74家试点医院内,共发放121482份慢阻肺筛查问卷(COPD-PS问卷),并将问卷评分≥5分的人群定义为慢阻肺高危人群。使用χ^(2)检验和二元logistic回归分析对慢阻肺高危人群在性别、年龄、地区中的分布情况及慢阻肺相关危险因素进行统计学分析。结果共发放问卷121482份,收回110102份,有效率为90.6%,在符合条件的110102名居民中筛出高危人群17421名,慢阻肺高危人群比例为15.8%;男性相比于女性高危人群比例更高(16.3%比15.2%,χ^(2)=25.66,P<0.001);慢阻肺高危人群比例随着年龄的增长而增加,≥40岁人群更易成为慢阻肺高危人群(χ^(2)=18445.92,P<0.001)。与非高危人群比较,慢阻肺高危人群有吸烟史者多(60.2%比17.3%,χ^(2)=14756.54,P<0.001),有二手烟接触史者多(47.2%比23.0%,χ^(2)=4349.43,P<0.001),长期生物燃料暴露人群较多(42.8%比14.5%,χ^(2)=7629.38,P<0.001),有职业粉尘(煤矿粉尘、矿石粉尘、铸造粉尘、电焊粉尘等)暴露人群较多(11.5%比4.9%,χ^(2)=1151.39,P<0.001),有环境或高危职业(石棉、铍、铀、氡气、柴油废气、煤烟和煤烟灰等)暴露人群较多(8.0%比3.8%,χ^(2)=608.65,P<0.001)。结论年龄≥40岁的老年人慢阻肺高危人群比例会随年龄增长而增加;具有吸烟史、二手烟接触史、生物燃料暴露史、职业粉尘暴露史、环境或高危职业暴露史都会导致慢阻肺高危人群比例的增加。应针对不同年龄段、不同性别、具备不同危险因素的普通人群进行早期筛查,早期预防干预,降低慢阻肺高危人群比例,从而降低患病率。

Objective To analyze the proportion of high-risk population for chronic obstructive pulmonary disease COPD and to explore the risk factors under the"China County COPD Standardization Management Center"("4C Center")project.Methods This was a cross-sectional study.Random cluster sampling was employed.During the five-year period from January 2016 to October 2021,in 74 pilot hospitals of 6 major regions(Northeast China,North China,East China,Central China,Northwest China,and Southwest China)under the"4C Center"project,a total of 121,482 COPD questionaires were distributed.Screening questionnaire(COPD-PS questionnaire)was used,and those with a score≥5 were defined as high-risk of COPD.The chi-square test and binary logistic regression analysis were used to analyze the distribution of high-risk groups of COPD in region,gender,and age,and to explore the related risk factors of COPD.Results A total of 121,482 questionnaires were distributed and 110,102 were collected,with an effective rate of 90.6%.From the eligible residents,17,421 high-risk people were screened out,with the proportion of 15.8%.The proportion of males was higher than that of females(16.3%vs 15.2%,χ^(2)=25.66,P<0.001).The proportion of patients at high risk of COPD increased with age,and those aged≥40 years were more likely to belong to the high-risk group(χ^(2)=18445.92,P<0.001).Compared with non-COPD high-risk group,in the high-risk group,more people smoked(60.2%vs 17.3%,χ^(2)=14756.54,P<0.001),more were exposed to second-hand smoke(47.2%vs 23.0%,χ^(2)=4349.43,P<0.001),more to long-term biofuels(42.8%vs 14.5%,χ^(2)=7629.38,P<0.001),more to occupational dust(coal mine dust,ore dust,casting dust,electric welding dust,etc.)(11.5%vs 4.9%,χ^(2)=1151.39,P<0.001),and more are involved in environmental or high-risk occupations(asbestos,beryllium,uranium,radon,diesel exhaust,soot,and soot,etc.)(8.0%vs 3.8%,χ^(2)=608.65,P<0.001).Conclusions The proportion of high-risk people of COPD in the elderly aged≥40 years increases accordingly;a history of smoking,second-hand smoke exposure,biofuel exposure,occupational dust exposure,and environmental or high-risk occupational exposure leads to high-risk COPD.In order to decrease the proportion,early screening and prevention should be carried out in the populations of different age groups,genders,and risk factors,thereby reducing the prevalence.