Abstract：
The major contributing risk factors to airflow obstruction (AO) in China remain largely unknown. We examined the environmental and lifestyle risk factors of unrecognized AO in the baseline of a population-based cohort drawn from 115 urban and rural communities across 12 provinces in China.
Amongst 46,285 adults recruited from 2005 to 2009, 3686 were identified with AO on spirometry (defined by the ratio of forced expiratory volume in the first second to forced vital capacity <0.7) and without known chronic lung disease. These cases were age- and sex-matched to 11,129 controls with normal spirometry and no chronic lung disease from the same community. Conditional multivariable adjusted OR and population attributable fraction (PAF) were calculated for each identified risk factor and their combined effect.
Compared to controls, smoking initiation age <20 years (OR 1.22 [95% CI 1.01-1.48]), smoking duration ≥40 years (OR 1.82 [1.50-2.22]), low vegetables (OR 1.86 [1.67-2.07]) and fruits (OR 1.14 [1.02-1.29]) intake, cooking with biomass fuels (OR 2.54 [2.32-2.78]) and poor kitchen ventilation (OR 1.37 [1.19-1.58]) were significantly associated with elevated risks of unrecognized AO. The combined effect of these lifestyle factors significantly elevated the odds by 25 fold (18.6-34.3). The addition of prior tuberculosis and low socioeconomic status further increased the odds to 40.1 (28.2-57.0) and the PAF to 66.7% (51.1-78.1).
Smoking, unhealthy diet, biomass cooking fuels and low socioeconomic status are strongly associated with AO. Addressing these risk factors could substantially reduce the burden of AO in China.
Amongst 46,285 adults recruited from 2005 to 2009, 3686 were identified with AO on spirometry (defined by the ratio of forced expiratory volume in the first second to forced vital capacity <0.7) and without known chronic lung disease. These cases were age- and sex-matched to 11,129 controls with normal spirometry and no chronic lung disease from the same community. Conditional multivariable adjusted OR and population attributable fraction (PAF) were calculated for each identified risk factor and their combined effect.
Compared to controls, smoking initiation age <20 years (OR 1.22 [95% CI 1.01-1.48]), smoking duration ≥40 years (OR 1.82 [1.50-2.22]), low vegetables (OR 1.86 [1.67-2.07]) and fruits (OR 1.14 [1.02-1.29]) intake, cooking with biomass fuels (OR 2.54 [2.32-2.78]) and poor kitchen ventilation (OR 1.37 [1.19-1.58]) were significantly associated with elevated risks of unrecognized AO. The combined effect of these lifestyle factors significantly elevated the odds by 25 fold (18.6-34.3). The addition of prior tuberculosis and low socioeconomic status further increased the odds to 40.1 (28.2-57.0) and the PAF to 66.7% (51.1-78.1).
Smoking, unhealthy diet, biomass cooking fuels and low socioeconomic status are strongly associated with AO. Addressing these risk factors could substantially reduce the burden of AO in China.
摘要：
目的：中国气流阻塞（AO）的主要危险因素仍不清楚。我们从中国12个省的115个城市和农村社区中抽取的基于人群的队列基线中检查了未识别的AO的环境和生活方式风险因素。
方法：在2005年至2009年招募的46,285名成年人中，有3686人在肺活量测定（定义为第一秒用力呼气量与用力肺活量之比<0.7）中被确定为AO，并且没有已知的慢性肺部疾病。这些病例的年龄和性别与来自同一社区的11,129名正常肺活量测定且无慢性肺部疾病的对照者相匹配。计算每个确定的危险因素及其综合影响的条件多变量校正OR和人群归因分数（PAF）。
结果：与对照组相比，开始吸烟年龄<20岁(OR1.22[95%CI1.01-1.48])，吸烟时间≥40年（OR1.82[1.50-2.22]），低蔬菜（OR1.86[1.67-2.07]）和水果（OR1.14[1.02-1.29]）摄入量，用生物质燃料烹饪(OR2.54[2.32-2.78])和厨房通风不良(OR1.37[1.19-1.58])与未识别AO风险升高显著相关.这些生活方式因素的综合作用使几率显着提高了25倍（18.6-34.3）。先前的结核病和低社会经济地位的增加进一步增加了几率到40.1（28.2-57.0），PAF增加到66.7％（51.1-78.1）。
结论：吸烟，不健康的饮食,生物质烹饪燃料和低社会经济地位与AO密切相关。解决这些风险因素可以大大减轻AO在中国的负担。
方法：在2005年至2009年招募的46,285名成年人中，有3686人在肺活量测定（定义为第一秒用力呼气量与用力肺活量之比<0.7）中被确定为AO，并且没有已知的慢性肺部疾病。这些病例的年龄和性别与来自同一社区的11,129名正常肺活量测定且无慢性肺部疾病的对照者相匹配。计算每个确定的危险因素及其综合影响的条件多变量校正OR和人群归因分数（PAF）。
结果：与对照组相比，开始吸烟年龄<20岁(OR1.22[95%CI1.01-1.48])，吸烟时间≥40年（OR1.82[1.50-2.22]），低蔬菜（OR1.86[1.67-2.07]）和水果（OR1.14[1.02-1.29]）摄入量，用生物质燃料烹饪(OR2.54[2.32-2.78])和厨房通风不良(OR1.37[1.19-1.58])与未识别AO风险升高显著相关.这些生活方式因素的综合作用使几率显着提高了25倍（18.6-34.3）。先前的结核病和低社会经济地位的增加进一步增加了几率到40.1（28.2-57.0），PAF增加到66.7％（51.1-78.1）。
结论：吸烟，不健康的饮食,生物质烹饪燃料和低社会经济地位与AO密切相关。解决这些风险因素可以大大减轻AO在中国的负担。
