Prevalence and risk factors of chronic obstructive pulmonary disease in residents aged 40 years and above in Shijingshan district of Beijing

doi:10.3877/cma.j.issn.1674-0785.2023.06.015

Abstract

Abstract:

Objective

To investigate the prevalence and risk factors of chronic obstructive pulmonary disease (COPD) in residents aged 40 years and above in Shijingshan district of Beijing.

Methods

The residents aged 40 years and above in 10 communities of Shijingshan district of Beijing were included by random sampling method from June to December 2019. Questionnaire survery, physical measurement, pulmonary function examination before and after bronchodilator treatment were conducted on all the subjects. COPD was diagnosed based on the 2020 Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria. The prevalence of COPD and related risk factors were investigated in those subjects.

Results

A total of 4 096 participants had reliable post-bronchodilator results and were included in the final analysis, including 1 886 males (46.0%) and 2 210 females (54.0%). The overall prevalence of COPD was 10.2%, and it was higher in men (13.8%) than in women (7.1%). The prevalence of COPD increased with age. Among adults with COPD, 49.8% (95%) had moderate or severe disease (GOLD stageⅡ-Ⅳ), 37.5% reported that they had a previous pulmonary function test, and 12.5% knew their diagnosis of COPD. Smoking was the main risk factor for COPD (odds ratio [OR]=1.94,95% confidence interval [CI]:1.45-2.58, P＜0.05). The prevalence of COPD was positively related to the pack-years of smoking. Certain COPD patients had not quit smoking although they knew that they had COPD. Other risk factors for COPD included male gender (OR=1.52, 95%CI: 1.22-2.05, P＜0.05), older age (OR=1.66, 95%CI: 1.34-2.41, P＜0.05), family history of lung disease (OR=1.73, 95%CI: 1.33-2.23, P＜0.05), and history of bronchitis/pneumonia in childhood (OR=2.035, 95%CI: 1.339-3.095, P＜0.05).

Conclusions

The prevalence of COPD in Shijingshan residents aged 40 and above is high. Strategies for prevention, early diagnosis, and management of COPD are urgently needed to reduce COPD-related burden.

Key words: Chronic obstructive pulmonary disease, Prevalence, Risk factors

Peipei Sun, Erming Zhang, Yanwei Shi, Chunyan Zhao, Pingping Song, Shuo Zhang, Ke Zhang, Yujiao Zhou, Can Zhao, Wei Yan, Rongju Wu, Liping Song, Weian Guo, Shitou Ma, Xinhua An, Caoxin Bao, Pingchao Xiang. Prevalence and risk factors of chronic obstructive pulmonary disease in residents aged 40 years and above in Shijingshan district of Beijing[J]. Chinese Journal of Clinicians(Electronic Edition), 2023, 17(06): 711-719.

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URL: https://zhlcyszz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-0785.2023.06.015

https://zhlcyszz.cma-cmc.com.cn/EN/Y2023/V17/I06/711

Figures/Tables 7

抽样阶段	样本分配	抽样方法
第一阶段	9个街道+北方工业大学校医院	与人口规模成比例的抽样（PPS）
第二阶段	抽取居委会	与人口规模成比例的抽样（PPS）
第三阶段	抽取居民户（含40岁及以上居民）	简单随机抽样
第四阶段	每户随机抽取1人	KISH表法

项目	总体（n=4096）	男性（n=1886）	女性（n=2210）
平均年龄（岁， $x ¯$ ）	60.70±11.44	60.35±11.53	60.99±11.34
体质指数（kg/m²， $x ¯$ ±s）	25.37±5.60	25.65±7.08	25.14±3.86
教育水平（%）
小学及更低	8.6	5.7	11.1
中学	65.5	64.2	66.6
大学及更高	25.9	30.1	22.3
吸烟（%）
从不吸烟	65.3	32.3	93.5
以前吸烟	11.8	23.3	1.9
目前仍吸烟	22.9	44.4	4.6
吸烟暴露（平均包年数）	23.23	24.07	18.38
0包（%）	65.3	32.3	93.5
1~9包（%）	8.4	14.3	3.4
10~19包（%）	7.9	15.4	1.5
≥20包（%）	18.4	38.0	1.6
家庭被动吸烟（%）
0	66.4	81.2	53.8
被动1	27.8	14.9	38.8
被动≥2	5.8	3.9	7.4
工作被动吸烟（%）
0	55.0	46.0	62.6
被动1	4.2	4.4	3.9
被动≥2	40.9	46.9	33.5
接触油烟（%）	86.1	78.5	92.6
接触煤燃料（%）	13.8	14.2	13.5
粉尘接触（%）	26.6	32.5	21.5
工作性质（%）
无业	5.0	3.6	6.3
务农	2.9	1.9	3.7
技术	37.1	43.8	31.4
管理	19.6	23.1	16.6
服务	17.1	12.0	21.5
其他	18.3	15.7	20.6
收入（%）
低等	4.2	3.0	5.2
中等	64.9	55.9	72.7
高等	30.9	41.1	22.2
早产儿（%）	0.8	0.6	1.0
过敏史（%）	19.7	17.3	21.8
家族史（%）	15.6	14.4	16.6
肺结核病史（%）	3.5	3.9	3.1
幼时支气管炎/肺炎病史（%）	8.7	8.3	9.0
幼时慢性咳嗽（%）	5.3	4.1	6.4
听过COPD（%）	37.1	32.2	41.2
未听过COPD（%）	62.9	67.7	58.8
做过肺功能（%）	24.0	23.5	24.3
未做过肺功能（%）	76.0	76.5	75.7
咳嗽（%）
从不	55.9	52.9	58.4
偶尔	39.5	41.4	37.8
经常	4.6	5.7	3.8
咳痰（%）
从不	60.7	57.5	63.4
偶尔	35.5	37.9	33.6
经常	3.8	4.7	3.0
喘息（%）
从不	77.1	75.2	78.6
偶尔	20.6	22.1	19.4
经常	2.3	2.7	2.0
气短（%）
从不	59.8	58.0	61.3
偶尔	36.0	37.5	34.7
经常	4.2	4.5	4.0
疲劳（%）
从不	56.6	54.5	58.5
偶尔	37.0	39.0	35.3
经常	6.4	6.6	6.2
肺功能（ $x ¯$ ±s）
药前FEV1（L）	2.47±2.87	2.87±4.14	2.12±0.49
药后FEV1（L）	2.57±4.19	3.01±6.11	2.19±0.49
药前FVC（L）	3.04±0.95	3.51±1.07	2.63±0.58
药后FVC（L）	3.23±6.21	3.54±0.76	2.95±8.44
药前FEV1/FVC（%）	82.06±12.31	79.07±8.55	84.65±16.8
药后FEV1/FVC（%）	81.33±13.80	80.02±8.41	82.46±17.06

项目	总体（n=4096）	男性（n=1886）	女性（n=2210）
平均年龄（岁， $x ¯$ ）	60.70±11.44	60.35±11.53	60.99±11.34
体质指数（kg/m²， $x ¯$ ±s）	25.37±5.60	25.65±7.08	25.14±3.86
教育水平（%）
小学及更低	8.6	5.7	11.1
中学	65.5	64.2	66.6
大学及更高	25.9	30.1	22.3
吸烟（%）
从不吸烟	65.3	32.3	93.5
以前吸烟	11.8	23.3	1.9
目前仍吸烟	22.9	44.4	4.6
吸烟暴露（平均包年数）	23.23	24.07	18.38
0包（%）	65.3	32.3	93.5
1~9包（%）	8.4	14.3	3.4
10~19包（%）	7.9	15.4	1.5
≥20包（%）	18.4	38.0	1.6
家庭被动吸烟（%）
0	66.4	81.2	53.8
被动1	27.8	14.9	38.8
被动≥2	5.8	3.9	7.4
工作被动吸烟（%）
0	55.0	46.0	62.6
被动1	4.2	4.4	3.9
被动≥2	40.9	46.9	33.5
接触油烟（%）	86.1	78.5	92.6
接触煤燃料（%）	13.8	14.2	13.5
粉尘接触（%）	26.6	32.5	21.5
工作性质（%）
无业	5.0	3.6	6.3
务农	2.9	1.9	3.7
技术	37.1	43.8	31.4
管理	19.6	23.1	16.6
服务	17.1	12.0	21.5
其他	18.3	15.7	20.6
收入（%）
低等	4.2	3.0	5.2
中等	64.9	55.9	72.7
高等	30.9	41.1	22.2
早产儿（%）	0.8	0.6	1.0
过敏史（%）	19.7	17.3	21.8
家族史（%）	15.6	14.4	16.6
肺结核病史（%）	3.5	3.9	3.1
幼时支气管炎/肺炎病史（%）	8.7	8.3	9.0
幼时慢性咳嗽（%）	5.3	4.1	6.4
听过COPD（%）	37.1	32.2	41.2
未听过COPD（%）	62.9	67.7	58.8
做过肺功能（%）	24.0	23.5	24.3
未做过肺功能（%）	76.0	76.5	75.7
咳嗽（%）
从不	55.9	52.9	58.4
偶尔	39.5	41.4	37.8
经常	4.6	5.7	3.8
咳痰（%）
从不	60.7	57.5	63.4
偶尔	35.5	37.9	33.6
经常	3.8	4.7	3.0
喘息（%）
从不	77.1	75.2	78.6
偶尔	20.6	22.1	19.4
经常	2.3	2.7	2.0
气短（%）
从不	59.8	58.0	61.3
偶尔	36.0	37.5	34.7
经常	4.2	4.5	4.0
疲劳（%）
从不	56.6	54.5	58.5
偶尔	37.0	39.0	35.3
经常	6.4	6.6	6.2
肺功能（ $x ¯$ ±s）
药前FEV1（L）	2.47±2.87	2.87±4.14	2.12±0.49
药后FEV1（L）	2.57±4.19	3.01±6.11	2.19±0.49
药前FVC（L）	3.04±0.95	3.51±1.07	2.63±0.58
药后FVC（L）	3.23±6.21	3.54±0.76	2.95±8.44
药前FEV1/FVC（%）	82.06±12.31	79.07±8.55	84.65±16.8
药后FEV1/FVC（%）	81.33±13.80	80.02±8.41	82.46±17.06

项目	总体	男性	女性	项目	总体	男性	女性
患病率	10.2	13.8	7.1	患病率	10.2	13.8	7.1
年龄（岁）				防护
40~49	5.6	6.8	4.5	有	13.3	13.4	13.1
50~59	9.6	11.1	8.1	无	15.7	19.5	11.1
60~69	9.7	15.7	6.5	χ²值	1.255	4.041	0.480
70~79	11.2	18.3	6.5	P值	0.263	0.044	0.488
80以上	19.5	27.2	12.6	早产儿
χ²值	51.676	48.251	13.786	是	8.8	8.3	9.1
P值	＜0.001	＜0.001	＜0.001	否	10.2	13.8	7.0
体质指数（kg/m²）				χ²值	0.067	0.302	0.140
＜18.5	8.6	15.8	7.7	P值	0.796	0.583	0.708
≥18.5~24	12.4	16.9	8.4	过敏史
≥24~28	9.4	12.9	6.3	是	12.0	15.0	10.0
≥28	8.1	10.6	5.9	否	9.7	13.5	6.2
χ²值	12.481	8.449	2.853	χ²值	3.825	0.514	7.992
P值	0.006	0.038	0.415	P值	0.050	0.473	0.005
教育水平				呼吸道家族史
小学或更低	13.9	25.0	9.0	有	16.1	22.4	11.5
中学	10.4	14.5	7.0	无	9.1	12.3	6.2
大学或更高	8.3	10.0	6.3	χ²值	29.696	19.966	13.042
χ²值	9.578	18.738	1.833	P值	＜0.001	＜0.001	＜0.001
P值	0.008	<0.001	0.400	肺结核病史
收入水平				有	18.3	23.0	13.2
低	7.0	8.8	6.1	无	9.9	13.4	6.9
中	10.8	15.9	7.4	χ²值	10.717	5.470	4.080
高	9.3	11.2	6.1	P值	0.001	0.019	0.043
χ²值	0.196	9.444	1.122	幼时肺炎支气管炎
P值	0.123	0.009	0.571	有	20.2	28.7	13.5
工作性质				无	9.2	12.4	6.4
无业	10.7	14.9	8.6	χ²值	42.921	31.889	13.906
务农	12.0	19.4	8.6	P值	＜0.001	＜0.001	＜0.001
技术	11.3	14.3	7.8	幼时慢性咳嗽病史
管理	9.5	13.6	4.6	有	26.0	41.6	17.6
服务	8.4	13.7	5.9	无	9.3	12.1	6.5
其他	9.7	11.8	8.4	χ²值	63.871	52.098	24.634
χ²值	5.595	2.194	7.269	P值	＜0.001	＜0.001	＜0.001
P值	0.348	0.822	0.201	咳嗽
吸烟状态				从不	7.5	9.2	6.2
从不吸烟	7.2	7.9	7.0	偶尔	12.6	17.7	7.8
吸烟	15.8	16.6	8.3	经常	21.6	28.0	13.3
以前吸烟	19.5	20.5	9.3	χ²值	54.869	45.714	6.970
仍吸烟	13.8	14.6	7.9	P值	＜0.001	＜0.001	0.031
χ²值	74.975	26.379	0.381	咳痰
P值	<0.001	<0.001	0.537	从不	7.6	9.2	6.4
吸烟暴露（包年）				偶尔	13.3	18.5	8.2
0	7.2	7.9	7.0	经常	21.9	31.8	9.0
＜9	12.7	14.1	7.9	χ²值	56.613	56.326	2.960
＜19	14.9	15.5	9.1	P值	＜0.001	＜0.001	0.228
患病率	10.2	13.8	7.1	患病率	10.2	13.8	7.1
＞20	17.6	18.0	8.6	喘息
χ²值	4.431	2.493	0.047	从不	6.9	9.2	5.0
P值	0.109	0.288	0.977	偶尔	19.2	25.7	12.9
室内油烟暴露				经常	38.9	46.0	31.1
是	9.3	13.8	6.1	χ²值	198.789	118.654	72.693
否	15.3	13.8	18.9	P值	＜0.001	＜0.001	＜0.001
χ²值	13.321	＜0.001	37.876	气短
P值	＜0.001	0.996	＜0.001	从不	6.5	9.3	4.3
燃煤暴露				偶尔	14.0	18.2	10.2
是	10.6	15.7	6	经常	28.2	34.1	22.5
否	9.3	13.5	7.2	χ²值	121.387	59.519	59.566
χ²值	0.327	0.935	0.569	P值	＜0.001	＜0.001	＜0.001
P值	0.567	0.334	0.451	疲劳
工作中接触粉尘				从不	8.4	12.3	5.3
是	14.6	16.6	12.0	偶尔	12.1	15.5	8.8
否	8.5	12.4	5.7	经常	14.9	16.1	13.9
χ²值	32.264	6.223	22.517	χ²值	20.877	4.400	19.866
P值	＜0.001	0.013	＜0.001	P值	＜0.001	0.111	＜0.001

项目	总体	男性	女性	项目	总体	男性	女性
患病率	10.2	13.8	7.1	患病率	10.2	13.8	7.1
年龄（岁）				防护
40~49	5.6	6.8	4.5	有	13.3	13.4	13.1
50~59	9.6	11.1	8.1	无	15.7	19.5	11.1
60~69	9.7	15.7	6.5	χ²值	1.255	4.041	0.480
70~79	11.2	18.3	6.5	P值	0.263	0.044	0.488
80以上	19.5	27.2	12.6	早产儿
χ²值	51.676	48.251	13.786	是	8.8	8.3	9.1
P值	＜0.001	＜0.001	＜0.001	否	10.2	13.8	7.0
体质指数（kg/m²）				χ²值	0.067	0.302	0.140
＜18.5	8.6	15.8	7.7	P值	0.796	0.583	0.708
≥18.5~24	12.4	16.9	8.4	过敏史
≥24~28	9.4	12.9	6.3	是	12.0	15.0	10.0
≥28	8.1	10.6	5.9	否	9.7	13.5	6.2
χ²值	12.481	8.449	2.853	χ²值	3.825	0.514	7.992
P值	0.006	0.038	0.415	P值	0.050	0.473	0.005
教育水平				呼吸道家族史
小学或更低	13.9	25.0	9.0	有	16.1	22.4	11.5
中学	10.4	14.5	7.0	无	9.1	12.3	6.2
大学或更高	8.3	10.0	6.3	χ²值	29.696	19.966	13.042
χ²值	9.578	18.738	1.833	P值	＜0.001	＜0.001	＜0.001
P值	0.008	<0.001	0.400	肺结核病史
收入水平				有	18.3	23.0	13.2
低	7.0	8.8	6.1	无	9.9	13.4	6.9
中	10.8	15.9	7.4	χ²值	10.717	5.470	4.080
高	9.3	11.2	6.1	P值	0.001	0.019	0.043
χ²值	0.196	9.444	1.122	幼时肺炎支气管炎
P值	0.123	0.009	0.571	有	20.2	28.7	13.5
工作性质				无	9.2	12.4	6.4
无业	10.7	14.9	8.6	χ²值	42.921	31.889	13.906
务农	12.0	19.4	8.6	P值	＜0.001	＜0.001	＜0.001
技术	11.3	14.3	7.8	幼时慢性咳嗽病史
管理	9.5	13.6	4.6	有	26.0	41.6	17.6
服务	8.4	13.7	5.9	无	9.3	12.1	6.5
其他	9.7	11.8	8.4	χ²值	63.871	52.098	24.634
χ²值	5.595	2.194	7.269	P值	＜0.001	＜0.001	＜0.001
P值	0.348	0.822	0.201	咳嗽
吸烟状态				从不	7.5	9.2	6.2
从不吸烟	7.2	7.9	7.0	偶尔	12.6	17.7	7.8
吸烟	15.8	16.6	8.3	经常	21.6	28.0	13.3
以前吸烟	19.5	20.5	9.3	χ²值	54.869	45.714	6.970
仍吸烟	13.8	14.6	7.9	P值	＜0.001	＜0.001	0.031
χ²值	74.975	26.379	0.381	咳痰
P值	<0.001	<0.001	0.537	从不	7.6	9.2	6.4
吸烟暴露（包年）				偶尔	13.3	18.5	8.2
0	7.2	7.9	7.0	经常	21.9	31.8	9.0
＜9	12.7	14.1	7.9	χ²值	56.613	56.326	2.960
＜19	14.9	15.5	9.1	P值	＜0.001	＜0.001	0.228
患病率	10.2	13.8	7.1	患病率	10.2	13.8	7.1
＞20	17.6	18.0	8.6	喘息
χ²值	4.431	2.493	0.047	从不	6.9	9.2	5.0
P值	0.109	0.288	0.977	偶尔	19.2	25.7	12.9
室内油烟暴露				经常	38.9	46.0	31.1
是	9.3	13.8	6.1	χ²值	198.789	118.654	72.693
否	15.3	13.8	18.9	P值	＜0.001	＜0.001	＜0.001
χ²值	13.321	＜0.001	37.876	气短
P值	＜0.001	0.996	＜0.001	从不	6.5	9.3	4.3
燃煤暴露				偶尔	14.0	18.2	10.2
是	10.6	15.7	6	经常	28.2	34.1	22.5
否	9.3	13.5	7.2	χ²值	121.387	59.519	59.566
χ²值	0.327	0.935	0.569	P值	＜0.001	＜0.001	＜0.001
P值	0.567	0.334	0.451	疲劳
工作中接触粉尘				从不	8.4	12.3	5.3
是	14.6	16.6	12.0	偶尔	12.1	15.5	8.8
否	8.5	12.4	5.7	经常	14.9	16.1	13.9
χ²值	32.264	6.223	22.517	χ²值	20.877	4.400	19.866
P值	＜0.001	0.013	＜0.001	P值	＜0.001	0.111	＜0.001

分级	所有人（n=416）	性（n=260）	女性（n=156）
Ⅰ级（轻）	209（50.2）	126（48.5）	83（53.2）
Ⅱ级（中）	171（41.1）	111（42.7）	60（38.5）
Ⅲ级（重）	28（6.7）	20（7.7）	8（5.1）
Ⅳ级（极重度）	8（1.9）	3（1.2）	5（3.2）

项目	例数	咳嗽	咳痰	喘息	气短	具备任一项
COPD患者	416	58.7	53.4	45.4	58.7	79.3
40~49岁	44	54.5	47.7	40.9	47.7	65.9
50~59岁	118	48.3	45.8	44.1	62.7	78.8
60~69岁	128	60.9	59.4	43.8	59.4	81.3
70~79岁	61	62.3	55.7	49.2	60.7	82.0
≥80岁	65	72.3	56.9	50.8	55.4	83.1
χ²值		11.123	5.629	1.690	3.382	5.955
P值		0.025	0.229	0.792	0.496	0.203
性别
男性	260	59.2	55.0	44.6	58.8	79.2
女性	156	57.7	50.6	46.8	58.3	79.5
χ²值		0.095	0.744	0.187	0.011	0.004
P值		0.758	0.388	0.666	0.918	0.950
GOLD分级
Ⅰ	209	53.1	48.3	34.0	52.2	77.0
Ⅱ	171	59.1	52.6	49.1	61.4	78.4
Ⅲ/Ⅳ	36	88.9	86.1	94.4	83.3	97.2
χ²值		16.231	17.681	46.896	13.217	7.794
P值		＜0.001	＜0.001	＜0.001	0.00137	0.020

项目	总人数	非COPD人群	COPD患者	χ²值	P值
例数	4096	3680	416
知道自己患有COPD	1.3	0	12.5	465.915	＜0.001
听说过COPD	37.1	36.5	43.0	6.893	0.032
曾行肺功能检查	24.0	22.4	37.5	46.472	＜0.001
以上均不知晓	53.4	54.5	43.5	18.177	＜0.001

项目	COPD患者	GOLD Ⅰ	GOLD Ⅱ	GOLD Ⅲ/Ⅳ	χ²值	P值
例数	416	209	171	36
知道自己患有COPD	12.5	5.3	17.5	30.6	24.715	＜0.001
听说过COPD	43.0	41.1	42.6	55.6	2.614	0.271
曾行肺功能检查	37.5	31.6	37.4	72.2	21.645	＜0.001
以上均不知晓	43.5	44.5	45.6	27.8	4.016	0.134

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