取暖固体燃料暴露及其时长对30~79岁居民呼吸系统疾病发病风险影响的前瞻性研究

A prospective study on the relationship between exposure to solid fuels for heating and its duration and the risk of morbidity of respiratory diseases among residents aged 30-79 years

目的探讨取暖固体燃料暴露及其时长与呼吸系统疾病发病风险之间的关联。方法利用中国慢性病前瞻性研究四川省彭州市项目点数据,采用Cox比例风险回归模型分析取暖固体燃料暴露及其时长与总呼吸系统疾病发病风险之间的关联,进一步分析其与呼吸系统疾病中慢性阻塞性肺疾病(COPD)、肺炎发病风险之间的关联。结果共纳入46082名30~79岁研究对象,冬季11634名(25.25%)进行取暖,其中8885名(19.28%)使用清洁燃料,2749名(5.97%)使用固体燃料;34448名(74.75%)不取暖。控制多个混杂因素后,Cox比例风险回归模型分析显示,与清洁燃料相比,不取暖降低总呼吸系统疾病(HR=0.81,95%CI:0.77~0.86)、COPD(HR=0.86,95%CI:0.78~0.95)、肺炎(HR=0.80,95%CI:0.74~0.86)的发病风险;固体燃料暴露增加总呼吸系统疾病的发病风险(HR=1.10,95%CI:1.01~1.20),与COPD、肺炎的发病风险无统计学关联。与没有固体燃料暴露相比,随着固体燃料暴露时长增加,总呼吸系统疾病(1~19年:HR=1.23,95%CI:1.10~1.37;20~39年:HR=1.25,95%CI:1.16~1.35;≥40年:HR=1.26,95%CI:1.15~1.39)及肺炎(1~19年:HR=1.21,95%CI:1.03~1.42;20~39年:HR=1.30,95%CI:1.16~1.46;≥40年:HR=1.35,95%CI:1.18~1.54)发病风险增加(趋势检验均P<0.001);固体燃料暴露时长1~19、20~39年使COPD的发病风险增加23%(HR=1.23,95%CI:1.02~1.49)、16%(HR=1.16,95%CI:1.00~1.35)。结论取暖固体燃料暴露增加了总呼吸系统疾病、COPD、肺炎的发病风险。

Objective To research the association between exposure to solid fuels for heating and its duration and the risk of respiratory diseases morbidity.Methods Data from the China Kadoorie Biobank project sited in Pengzhou City,Sichuan Province.Cox proportional hazard regression model was used to analyze the association between exposure to solid fuels for heating and its duration and the risk of total respiratory diseases and the association between exposure to solid fuels for heating and the risk of chronic obstructive pulmonary disease(COPD)and pneumonia among respiratory diseases.Results A total of 46082 participants aged 30-79 years were enrolled,with 11634(25.25%)heating during the winter,of whom 8885(19.28%)used clean fuels and 2749(5.97%)used solid fuels,of whom 34448(74.75%)did not heat.After controlling for multiple confounding factors,Cox proportional hazard regression model was used,which revealed that compared with clean fuels,unheating could reduce the risk of total respiratory disease(HR=0.81,95%CI:0.77-0.86),COPD(HR=0.86,95%CI:0.78-0.95)and pneumonia(HR=0.80,95%CI:0.74-0.86),respectively.Exposure to solid fuels increased the risk of total respiratory disease(HR=1.10,95%CI:1.01-1.20)and were not associated with COPD and pneumonia.Compared with no solid fuel exposure,the risk of total respiratory disease(1-19 years:HR=1.23,95%CI:1.10-1.37;20-39 years:HR=1.25,95%CI:1.16-1.35;≥40 years:HR=1.26,95%CI:1.15-1.39)and COPD(1-19 years:HR=1.21,95%CI:1.03-1.42;20-39 years:HR=1.30,95%CI:1.16-1.46;≥40 years:HR=1.35,95%CI:1.18-1.54)increased with the length of exposure of solid fuels(trend test P<0.001).Solid fuels exposure for 1-19 years and 20-39 years increased the risk of COPD by 23%(HR=1.23,95%CI:1.02-1.49)and 16%(HR=1.16,95%CI:1.00-1.35).Conclusion Heating solid fuels exposure increases the risk of total respiratory disease,COPD,and pneumonia.