Cross-sectional Study On The Relationship Between Smoking,Drinking And Hepatitis B Epidemic And Liver Function In Minority Areas Of Guizhou Province

Objective: To understand the situation of smoking and drinking in minority areas of Guizhou province,to explore the association between smoking and drinking and the prevalence of hepatitis B and liver function,provide scientific basis for finding high-risk populations with abnormal hepatitis B and liver function,reduce the risk of liver disease incidence and death,and develope effective prevention strategies.Methods: A multi-stage stratified cluster random sampling method was used to select residents who were resident in rural areas of Guizhou Province in the autonomous region of ethnic minorities with age ≥ 18 years old,and a questionnaire survey was conducted,which included demographic characteristics,life behavior history,hepatitis B vaccine history,etc.Blood samples were collected that were tested for hepatitis B serological indicators: hepatitis B surface antigen(HBs Ag),hepatitis B surface antibody(HBs Ab),hepatitis B core antibody(HBc Ab),simultaneously,five liver function indicators were also detected: Alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBIL),direct bilirubin(DBIL),and indirect bilirubin(IBIL).All data were analyzed by SPSS 22.0 software;Chi-square test was used for single factor analysis and non-conditional multi-class logistic regression analysis was used to analyze the lifestyle behaviors of smoking,drinking,and hepatitis B epidemic patterns(susceptible mode,infection mode,and immune mode);non-conditional binary logistic regression was explored the association between smoking,drinking,and HBV infection with abnormal liver function.Results: This study included 1,629 study subjects,and the total drinking rate was 42.97%,which the male and female drinking rates were 59.83% and 29.55%,respectively;the total smoking rate was 17.56%,which the male and female smoking rates were 38.78% and 0.66%,respectively;there was a statistical difference in the composition of the three prevalence patterns of whether the subject was drinking(P<0.05),while the composition of the three epidemic patterns of whether to smoke was not statistically different(P>0.05);the results of multi-class logistic regression analysis adjusting for multiple factors showed that the OR(95%CI)of susceptibility mode in drinking was1.34(1.03,1.74),and the OR(95%CI)of infection mode was 1.08(0.79,1.49);after further gender stratification,the adjusted OR(95%CI)of the hepatitis B susceptibility pattern in men was 1.90(1.25,2.90),while the susceptibility pattern and infection pattern in women were not statistically significant(P>0.05);compared with non-smokers adjusting for multiple factors,the OR(95%CI)of susceptibility mode in smoking was 0.86(0.61,1.20),and the OR(95%CI)of infection mode was0.96(0.64,1.45);after further gender stratification,there were no statistical significance in the susceptibility pattern and infection pattern of male and female hepatitis B(P>0.05);the abnormal rates of ALT,AST,TBIL and IBIL in the smokers were higher than those in the non-smokers(P>0.05),and the rates of five liver dysfunctions were higher in the drinkers than in the non-drinkers(P>0.05);the abnormal rate of ALT in HBV-positive people was higher than that in HBV-negative people(P>0.05);except for DBIL,the abnormal rate of liver function in "smoke only" was lower than that in "drinking only" and "HBV only";after adjusting multiple factors,unconditional binary logistic regression analysis showed that the a OR(95%CI)for the abnormal rates of ALT,AST,and DBIL were 2.43(1.54,3.84),2.07(1.27,3.37),and 1.53(1.16,2.02)compared with "no drinking + no smoking + HBV negative",while there were no statistical difference in the abnormal rates of TBIL and IBIL(P>0.05);"smoking only" and "HBV positive only" had no statistical difference in the five rates of liver dysfunction(P>0.05);in addition,compared with HBV infection,smoking,and drinking "all negative",the adjusted OR(95%CI)of "any positive,any two positive," and "all positive" for ALT abnormalities were2.37(1.57,3.58),5.24(3.42,8.03)and 7.42(3.78,14.59),the adjusted OR(95%CI)of the AST abnormality rate of these three groups were 1.96(1.26,3.06),5.01(3.19,7.87)and 5.66(2.75,11.68),the adjusted OR(95%CI)for the abnormal rate of DBIL were 1.53(1.17,2.01),2.32(1.68,3.21)and 2.23(1.15,4.34),the adjusted OR(95%CI)for TBIL abnormalities were 1.36(0.88,2.08),2.62(1.67,4.11),and 2.64(1.16,6.01),the adjusted OR(95%CI)for IBIL abnormality were 1.35(0.83,2.19),2.16(1.28,3.64),and1.77(0.65,4.79);the gender was further stratified,for the male population,,compared with "no drinking + no smoking + HBV negative",the "drinking only" adjusted the abnormal rate of ALT and AST OR(95%CI)were 3.47(1.69,7.14)and 3.44(1.59,7.47)after adjusting for multiple factors,and there was no statistical difference in the abnormal rates of TBIL,DBIL,and IBIL(P>0.05);"Smoking only" had no statistical difference in the five rates of liver dysfunction(P>0.05);the adjusted OR(95%CI)was 2.87(1.13,7.33)of “HBV-positive only” for the abnormal rate of ALT(P<0.05),there was no statistical difference in the other four liver function abnormalities(P>0.05);compared with HBV infection,smoking,and drinking "all negative",the adjusted OR(95%CI)of “any positive”,“any two positive”,and “all positive” for ALT abnormalities were 2.97(1.50,5.88),3.95(2.00,7.71)and 5.33(2.26,12.55),the adjusted OR(95%CI)of the AST abnormality rate of these three groups were 2.85(1.36,5.97),4.33(2.10,8.94),and 4.60(1.83,11.56),whereas there was no statistical difference between TBIL,DBIL and IBIL(P>0.05);for the female population,after adjusting for multiple factors,compared with "no drinking + no smoking + HBV negative",the adjusted OR(95% CI)of DBIL abnormality rate of "only drinking" was1.65(1.11,2.46);there was no statistical difference in the other four types of liver dysfunction(P>0.05);"HBV-positive only" had no statistical difference in the five types of liver dysfunction(P>0.05);compared with HBV infection,smoking,and drinking "all negative",the adjusted OR(95%CI)of ALT abnormality rate of "any positive one" and "any two positive" were 1.50(0.86,2.61)and 4.56(2.12,9.80)respectively;the adjusted OR(95%CI)for the abnormal rate of AST in both two groups were 1.10(0.59,2.06)and 3.57(1.54,8.30);the adjusted OR(95%CI)of the abnormal rate of TBIL was 1.07(0.59,1.93)and 3.98(1.82,8.72);the adjustment of the abnormal rate of DBIL The OR(95%CI)was 1.63(1.14,2.32)and 1.68(0.87,3.26);the adjusted OR(95%CI)for the abnormal rate of IBIL were 0.85(0.43,1.65)and3.28(1.37,7.84).Conclusion: Guizhou Province ’s minority population has a highsmoking rate(male)and high drinking rate;drinking in males is associated with HBV susceptibility patterns,and the prevalence of drinking and infection patterns is higher;drinking and HBV infections in males are associated with abnormal liver function,and the combination of smoking,drinking,and HBV infection has the greatest impact on liver function abnormalities in men;It is recommended that attention be paid to drinking and HBV infection in ethnic regions of Guizhou Province,simultaneously,health education and hepatitis B vaccination should be strengthened while living with drinking and smoking should be emphasized,so as to reduce risk of developing liver disease or liver cancer.