Articles
Prevalence and risk factors of chronic obstructive pulmonary disease in China (the China Pulmonary Health [CPH] study): a national cross-sectional study
Chen Wang, Jianying Xu, Lan Yang, et al
Lancet 2018 Available online 9 April 2018
Summary
Background 背景
Although exposure to cigarette smoking and air pollution is common, the current prevalence of chronic obstructive pulmonary disease (COPD) is unknown in the Chinese adult population. We conducted the China Pulmonary Health (CPH) study to assess the prevalence and risk factors of COPD in China.
尽管吸烟及空气非常非常普遍，但中国成年人中COPD的罹患率尚不清楚。我们进行了一项中国肺部健康(CPH)研究对中国COPD的罹患率及危险因素进行评估。
Methods 方法
The CPH study is a cross-sectional study in a nationally representative sample of adults aged 20 years or older from ten provinces, autonomous regions, and municipalities in mainland China. All participants underwent a post-bronchodilator pulmonary function test. COPD was diagnosed according to 2017 Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria.
CPH研究是在中国大陆10个省、自治区和直辖市进行的针对20岁以上成年人有全国代表性样本的一项横断面研究。所有人都接受支气管扩张剂后肺功能检查。根据2017年GOLD标准诊断COPD。
Findings 结果
Between June, 2012, and May, 2015, 57 779 individuals were invited to participate, of whom 50 991 (21 446 men and 29 545 women) had reliable post-bronchodilator results and were included in the final analysis. The overall prevalence of spirometry-defined COPD was 8·6% (95% CI 7·5–9·9), accounting for 99·9 (95% CI 76·3–135·7) million people with COPD in China. Prevalence was higher in men (11·9%, 95% CI 10·2–13·8) than in women (5·4%, 4·6–6·2; p<0·0001 for sex difference) and in people aged 40 years or older (13·7%, 12·1–15·5) than in those aged 20–39 years (2·1%, 1·4–3·2; p<0·0001 for age difference). Only 12·0% (95% CI 8·1–17·4) of people with COPD reported a previous pulmonary function test. Risk factors for COPD included smoking exposure of 20 pack-years or more (odds ratio [OR] 1·95, 95% CI 1·53–2·47), exposure to annual mean particulate matter with a diameter less than 2·5 μm of 50–74 μg/m3 (1·85, 1·23–2·77) or 75 μg/m3 or higher (2·00, 1·36–2·92), underweight (body-mass index <18·5 kg/m2; 1·43, 1·03–1·97), sometimes childhood chronic cough (1·48, 1·14–1·93) or frequent cough (2·57, 2·01–3·29), and parental history of respiratory diseases (1·40, 1·23–1·60). A lower risk of COPD was associated with middle or high school education (OR 0·76, 95% CI 0·64–0·90) and college or higher education (0·47, 0·33–0·66).
2012年6月至2015年5月间，共有57779人受邀参加研究，其中50991人（21446名男性，29545名女性）有可靠的支气管扩张剂后检查结果，因而纳入最终分析。经肺量计诊断的COPD患病率为8·6% (95% CI 7·5–9·9)，相当于全国 99·9 (95% CI 76·3–135·7) 百万人罹患 COPD。男性患病率 (11·9%, 95% CI 10·2–13·8) 高于女性 (5·4%, 4·6–6·2; 性别差异 p<0·0001 )，40岁以上人群患病率 (13·7%, 12·1–15·5) 超过 20–39 岁人群 (2·1%, 1·4–3·2; 年龄差异 p<0·0001)。仅有 12·0% (95% CI 8·1–17·4) 的COPD患者既往接受过肺功能检查。COPD的危险因素包括吸烟超过20 包年 (比数比 [OR] 1·95, 95% CI 1·53–2·47)，年平均PM 2.5为50–74 μg/m3 (1·85, 1·23–2·77) 或 75 μg/m3 以上 (2·00, 1·36–2·92)，体重不足 (BMI <18·5 kg/m2; 1·43, 1·03–1·97)，儿童期偶尔慢性咳嗽 (1·48, 1·14–1·93) 或经常咳嗽 (2·57, 2·01–3·29)，以及父母呼吸疾病病史 (1·40, 1·23–1·60)。COPD的低危因素包括初中或高中教育背景 (OR 0·76, 95% CI 0·64–0·90) 及大学以上教育背景 (0·47, 0·33–0·66)。
Interpretation 结论
Spirometry-defined COPD is highly prevalent in the Chinese adult population. Cigarette smoking, ambient air pollution, underweight, childhood chronic cough, parental history of respiratory diseases, and low education are major risk factors for COPD. Prevention and early detection of COPD using spirometry should be a public health priority in China to reduce COPD-related morbidity and mortality.
中国成年人中经肺量计诊断的COPD患病率很高。吸烟、空气污染、体重不足、儿童期慢性咳嗽、父母呼吸疾病病史以及教育水平低是COPD的主要危险因素。在中国，预防或采用肺量计早期诊断COPD应当成为降低COPD罹患率及病死率的首要公共卫生策略。
Funding
Ministry of Health and Ministry of Science and Technology of China.
