Jindal S K, Aggarwal A N, Chaudhry K, Chhabra S K, D'Souza G A, Gupta D, Katiyar S K, Kumar R, Shah B, Vijayan V K
Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh-160012, India.
Indian J Chest Dis Allied Sci. 2006 Jan-Mar;48(1):23-9.
Population prevalence of chronic obstructive pulmonary disease (COPD) and its relationship with tobacco smoking, environmental tobacco smoke (ETS) exposure and other variables were studied in adult subjects of 35 years and above at four different centres in India. Question-items for the diagnosis of COPD were included in the questionnaire used for the field study on asthma epidemiology.
Field surveys were conducted in both the urban and the rural populations at Bangalore, Chandigarh, Delhi and Kanpur with the help of a structured and validated questionnaire for diagnosis of asthma and COPD. Separate sets of questions were used for the diagnoses of the two diseases. A two-stage stratified sample design was employed where a village or an urban locality formed the first stage unit and a household formed the second stage unit. A uniform methodology was used at all the four centres and the analyses were done at the central coordinating centre--Chandigarh. Chronic obstructive pulmonary disease, defined by chronic bronchitis (CB) criteria, was diagnosed from the presence of cough and expectoration on most of the days for at least three months in a year for two consecutive years or more.
Chronic obstructive pulmonary disease was diagnosed in 4.1% of 35295 subjects, with a male to female ratio of 1.56:1 and a smoker to nonsmoker ratio of 2.65: 1. Prevalence among bidi and cigarette smokers was 8.2% and 5.9%, respectively. Odds ratio (OR) for COPD was higher for men, elderly individuals, lower socio-economic status and urban (or mixed) residence. Environmental tobacco smoke exposure among nonsmokers had an OR of 1.4(95% CI 1.21-1.61). Combined exposure to both ETS and solid fuel combustion had higher OR than for ETS exposure alone.
Population prevalence of COPD is very high in India with some centre to centre differences. Smoking of both bidis and cigarettes, and ETS exposure among nonsmokers, were two important risk factors at all centres. It is important to employ uniform methodology for assessment of national burden and disease-surveillance programme.
在印度四个不同中心，对35岁及以上的成年受试者进行了慢性阻塞性肺疾病（COPD）的人群患病率及其与吸烟、环境烟草烟雾（ETS）暴露和其他变量关系的研究。用于哮喘流行病学现场研究的问卷中包含了COPD诊断的问题项。
借助一份用于哮喘和COPD诊断的结构化且经过验证的问卷，在班加罗尔、昌迪加尔、德里和坎普尔的城市和农村人口中开展了现场调查。这两种疾病的诊断使用了不同的问题集。采用两阶段分层抽样设计，其中一个村庄或城市区域构成第一阶段单元，一个家庭构成第二阶段单元。在所有四个中心采用统一的方法，并在中央协调中心——昌迪加尔进行分析。根据慢性支气管炎（CB）标准定义的COPD，通过连续两年或更长时间内一年中大部分日子出现咳嗽和咳痰症状至少三个月来诊断。
在35295名受试者中，4.1%被诊断为COPD，男女比例为1.56:1，吸烟者与非吸烟者比例为2.65:1。比迪烟和卷烟吸烟者中的患病率分别为8.2%和5.9%。COPD的优势比（OR）在男性、老年人、社会经济地位较低者以及城市（或混合）居住者中更高。非吸烟者的ETS暴露OR为1.4（95%可信区间1.21 - 1.61）。同时暴露于ETS和固体燃料燃烧的OR高于单独的ETS暴露。
印度COPD的人群患病率非常高，且各中心之间存在一定差异。比迪烟和卷烟吸烟以及非吸烟者的ETS暴露在所有中心都是两个重要的危险因素。采用统一方法评估国家负担和疾病监测项目非常重要。
