| ObjectivesIn recent years,the prevalence of chronic obstructive pulmonary disease(COPD)has b een increasing in China and other parts of the world,and has caused a serious disease bur den.COPD has gradually become a major public health problem in China.Many studies at h ome and abroad have proved that living environment and occupational exposure are importa nt risk factors for COPD.However,there are few studies on the effects of living environm ent and occupational exposure on COPD in China.Therefore,this study analyzed the associa tion between living environment and occupational exposure and COPD by using the monitor ing data of COPD of residents over 40 years old in Jiangsu Province in 2015 and 2019,a nd explored the possible interactions among them,with a view to providing a basis for the formulation of related prevention and control policies.Methods1、In 2015 and 2019 using multi-stage stratified cluster random sampling method,six COPD monitoring stations in Jiangsu province from 12 months prior to the survey in monitoring living more than six months,and the age of 40 or more Chinese citizens:in each monitoring point,using the proportional to population size sampling(PPS)sampling method to extract three towns/street;2administrative villages/neighborhood committees were selected from each selected township/street using PPS sampling method;Each selected administrative village/neighborhood committee uses cluster random sampling method to select 1 village/resident group;100 households were selected from each selected village/residential group using a simple random sampling method;One resident≥40 years old was randomly selected from the selected households for investigation by KISH table method.2、Survey methods:Investigators trained uniformly and passed the assessment,using electronic tablet and information collection system,conducted face-to-face questionnaire survey with respondents;The height,weight,waist circumference,hip circumference,blood pressure and heart rate of the respondents were measured by standard methods using uniform technical specifications.Using portable pulmonary function meter,according to ATS quality control standard of lung function test,lung function test was performed on subjects without contraindications to lung function examination.3、Statistical method:SAS9.2 and SPSS 23.0 online software were used for data processing and analysis.In this study,all indicators of composition ratio and rate were calculated by complex weighting,and sampling design error was taken into account in all statistical tests to reduce class I errors.The specific methods are as follows:(1)The basic characteristics of the research object are described by composition ratio and ratio.A rate(%,95%CI)based on complex sampling and weighted calculation was used to describe the distribution characteristics of living environment and occupational exposure of people over 40 years old in Jiangsu Province.(2)The prevalence of COPD in different populations with different characteristics was described by complex sampling and weighting(%,95%CI),and the prevalence of COPD in different populations with different characteristics was compared by Rao-Scottχ~2based on complex sampling and weighting.(3)Univariate and multivariate analyses were conducted based on complex sampling and weighted logistic model to explore the effects of living environment and occupational exposure on the risk of COPD.(4)The potential additive interaction of living environment and occupational exposure on COPD were analyzed by using the Excel table compiled by Andersson.The additive interaction was evaluated by Relative Excess Risk of Interaction(RERI),Attributable Proportion(AP),Synergy Index(S).Results(1)Among the subjects,there were 2919 males(45.15%)and 3539 females(54.85%);Among the age groups,2235(34.93%)were aged from 50 to 59 years old.2898 students(41.09%)had primary school education or below;Among the respondents,1881(28.63%)were current smokers,and 578(8.64%)were former smokers.1634 people(23.03%)were exposed to cooking polluting fuel;183 people(4.93%)were exposed to heating pollution fuel;2,838 persons(45.36%)were exposed to occupation;2507 persons(39.95%)exposed to dust;2107 people(32.98%)were exposed to harmful gases.(2)Of the 6,458 subjects,777 patients had COPD,with a prevalence of 10.98%(95CI:7.23%-31.58%).The results showed that the prevalence of COPD was higher among men,older people,people with low education level,unmarried people,people with low body weight,smokers,people with a history of cooking pollution fuel exposure,occupational exposure,exposure to dust and/or harmful gases,civil engineering and other occupations,and people with agricultural production.Among the people with occupational exposure,the prevalence of COPD was higher in those who did not take occupational protective measures,and the difference was statistically significant.(3)Multivariate logistic results showed that among all subjects,the risk of COPD was 1.58 times(95%CI:1.01-2.47)and 2.31 times(95%CI:1.49-3.60)for former and current smokers compared with those who had never smoked.Those with a history of exposure to harmful gases had a 1.2 times higher risk(95%CI:1.04-1.39)than those without.Working in fields and other occupations also increased the risk of COPD by 1.48 times(95%CI:1.33-1.65)and 1.27 times(95%CI:1.01-1.60),respectively,compared with non-working individuals.In rural populations,the risk of COPD was 2.52 times that of non-use(95%CI:1.74-3.64);Kerosene/paraffin use was1.49 times more likely than non-use(95%CI:1.29-1.73);The risk of using firewood/straw was1.39 times that of not using it(95%CI:1.00-1.94);Among occupational hazard groups,the risk of COPD in those with occupational exposure who took protective measures was 0.66 times that of those who did not(95%CI:0.49-0.88).Among agricultural workers,the risk of COPD was 0.7 times that of non-workers(95%CI:0.51-0.97).All the above results were statistically significant.(4)There was an additive interaction between smoking and BMI≤24 kg/m~2for COPD.RERI=2.03(95%CI:1.11-2.94),AP=0.38(95%CI:0.25-0.51),S=1.87(95%CI:1.39-2.51).The results showed that the additive interaction accounted for 38%of the risk of COPD in smokers with BMI≤24 kg/m2,and their risk of COPD was 1.87 times higher than that of those exposed to a single risk factor.No interaction was found between smoking and different cooking fuels,and between smoking and different occupational exposures.Conclusions1、Both smoking and cooking fuel exposure in the living environment increased the risk of COPD.Although no interaction between smoking and different cooking fuels was found,both smoking and coal/carbon use and kerosene/paraffin use increased the risk of COPD.There was a synergistic additive interaction between smoking and BMI less than or equal to 24kg/m~2,which significantly increased the risk of COPD.Therefore,health education for smokers should be strengthened,natural gas transformation in rural areas should be accelerated,so that rural residents can use clean fuel,so as to achieve better primary prevention effect of COPD.At the same time,some attention and support should be given to the malnutrition that often occurs in patients with COPD,so as to prevent the synergistic effect of low body mass index caused by malnutrition and smoking,which increases the risk of COPD..2、Harmful gas contact,to engage in farmland production operation and other professional increased the risk of COPD,smoking and occupational exposure factors on the different interaction was detected in chronic obstructive pulmonary disease,but at the same time exposed to smoking and the harmful gas contact,work in the farm production’s risk is higher than exposed to a single factor,still need to pay attention to increase the risk of the disease.Occupational protection measures should be taken to reduce the risk of COPD,targeted on the occupational exposure to occupational exposure related to science,and puts forward protection measures for related industries rectification requirements,increase the rate of occupational exposure population protection,to improve the level of COPD prevention,reduce the cause of disease burden of copd has great potential. |
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