云南省农村居民慢性阻塞性肺疾病患病现况及基于结构方程模型的影响因素

Analysis of prevalence and determinants of chronic obstructive pulmonary disease in rural Yunnan Province based on structure equation modeling

目的分析云南省农村居民慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)患病现况及其影响因素。方法采用多阶段分层随机抽样方法抽取云南省农村地区7572名≥35岁常住居民进行现场问卷调查和体格检查,采用主成分分析法(principal component analysis,PCA)构建个体社会经济地位(socioeconomic status,SES),运用结构方程模型(structure equation modeling,SEM)分析COPD患病的影响因素。结果云南省农村居民COPD患病率为12.60%,男性患病率高于女性(χ^(2)=57.973,P<0.001);COPD患病率随年龄的增加而升高(χ^(2)_(趋势)=165.616,P<0.001);少数民族居民COPD患病率高于汉族居民(χ^(2)=33.785,P<0.001);SES越低,COPD患病率越高(χ^(2)_(趋势)=10.751,P<0.001)。SEM分析结果显示,性别、年龄、民族和SES对COPD患病具有直接和间接作用,其总路径系数分别为0.09、0.15、0.06和-0.05,而COPD家族史、低BMI、现在吸烟和被动吸烟对COPD患病只有直接作用,其路径系数分别为0.06、0.03、0.08和0.08。结论云南省农村居民COPD患病率较高,应加强对男性、高龄、吸烟、低BMI、有COPD家族史和SES较低人群的COPD健康教育和干预工作。

Objective The aim of this study was to analyze the prevalence and determinants of chronic obstructive pulmonary disease(COPD)in rural areas of Yunnan Province.Methods The multi-stage stratified random sampling method was used to conduct on-site questionnaire survey and physical examination among 7572 rural residents aged≥35 years from three counties in Yunnan Province.Principal component analysis was used to construct individual socioeconomic status(SES).Structure Equation Modeling(SEM)was used to analyze possible influencing factors of prevalence of COPD.Results Among the study population,the prevalence of COPD was 12.60%.Males had a significantly higher prevalence of COPD than females(15.54%and 9.73%,χ^(2)=57.973,P<0.001).Prevalence of COPD increased with age(χ^(2)_(trend)=165.616,P<0.001).Ethnic minority groups had a higher prevalence of COPD than Han majority(χ^(2)_(trend)=33.785,P<0.001).Individuals with lower SES had a higher prevalence of COPD than their counterparts(χ^(2)=10.751,P<0.001).The results of SEM analysis indicated that the following associated factors had both direct and indirect statistically significant effect on prevalence of COPD:gender(0.09),age(0.15),ethnicity(0.06),and SEP(-0.05)had both direct and indirect effects on prevalence of COPD,whereas family history of COPD(0.06),low BMI(0.03),current smoking(0.08),and passive smoking(0.08)only directly associated with prevalence of COPD.Conclusions The prevalence of COPD is high in rural Yunnan Province.Future health education and intervention to prevent and control COPD should focus on males,elderly people,current smokers,individuals with low BMI,and individuals with family history of COPD and low SES.