Wang Ke-Sheng, Wang Liang, Zheng Shimin, Wu Long-Yang
Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, Johnson City, USA.
The Jackson Laboratory, Bar Harbor, USA.
Int J High Risk Behav Addict. 2013 Sep;2(2):59-65. doi: 10.5812/ijhrba.10333. Epub 2013 Sep 20.
Chronic obstructive pulmonary disease (COPD) has been a major public health problem due to its high prevalence, morbidity, and mortality. Smoking is a major risk factor for COPD, while serious psychological distress (SPD) is prevalent among COPD patients. However, no study focusing on the effect of SPD on COPD has been so far conducted, while few studies have focused on the associations of SPD and behavioral factors with COPD by smoking status.
This study aimed to examine the associations of SPD and behavioral factors (such as smoking and physical activity) with COPD.
Weighted logistic regression models were used for the analysis of 1,248 cases and 39,995 controls from the 2005 California Health Interview Survey (CHIS).
The prevalence of SPD was 10% in cases and 4% in controls, respectively. The percentages of past and current smoking were higher in cases than controls (50% vs. 24% and 27% vs. 15%, respectively). After adjusting for other factors, smoking (OR = 4.56, 95% CI = 3.41-6.11 and OR = 3.24, 95% CI = 2.57-4.08 for current and past smoking, respectively), physical activity (OR = 0.69, 95% CI = 0.55-0.87), obesity (OR = 1.25, 95% CI = 1.03-1.52), older age (OR = 2.86, 95% CI = 2.15-3.82, and OR = 5.97, 95% CI = 4.42-8.08 for middle-aged and elder groups, respectively), SPD (OR = 2.11, 95% CI = 1.47-3.04), employment (OR = 0.62, 95% CI = 0.51-0.76), race (OR = 0.35, 95% CI = 0.23-0.54, OR = 0.59, 95% CI = 0.36-0.97, and OR = 0.47, 95% CI=0.29-0.75 for Latino, Asian, and African American, respectively) and lower federal poverty level (OR=1.89, 95% CI = 1.35-2.63, OR = 1.65, 95% CI = 1.27-2.14, and OR = 1.39, 95% CI = 1.12-1.72 for 0-99% FPL, 100-199% FPL and 200-299% FPL, respectively) were all associated with COPD (P < 0.05). Age group, SPD, race, and employment showed significant interactions with smoking status. Stratified by smoking status, aging was the only risk factor for COPD in the never smoking group; whereas, lack of physical activity, older age, SPD, race, unemployment, and lower federal poverty level were associated with COPD in the smoking groups.
Smoking and aging were major risk factors for COPD, while lack of physical activity and SPD were strongly associated with COPD in the smoking groups.
慢性阻塞性肺疾病（COPD）因其高患病率、发病率和死亡率一直是一个主要的公共卫生问题。吸烟是COPD的主要危险因素，而严重心理困扰（SPD）在COPD患者中普遍存在。然而，迄今为止尚未有研究关注SPD对COPD的影响，同时很少有研究关注SPD和行为因素与吸烟状态下COPD的关联。
本研究旨在探讨SPD和行为因素（如吸烟和体育活动）与COPD的关联。
采用加权逻辑回归模型对2005年加利福尼亚健康访谈调查（CHIS）中的1248例病例和39995例对照进行分析。
病例组和对照组中SPD的患病率分别为10%和4%。病例组中既往吸烟和当前吸烟的比例高于对照组（分别为50%对24%和27%对15%）。在调整其他因素后，吸烟（当前吸烟的OR = 4.56，95%CI = 3.41 - 6.11；既往吸烟的OR = 3.24，95%CI = 2.57 - 4.08）、体育活动（OR = 0.69，95%CI = 0.55 - 0.87）、肥胖（OR = 1.25，95%CI = 1.03 - 1.52）、年龄较大（中年组的OR = 2.86，95%CI = 2.15 - 3.82；老年组的OR = 5.97，95%CI = 4.42 - 8.08）、SPD（OR = 2.11，95%CI = 1.47 - 3.04）、就业（OR = 0.62，95%CI = 0.51 - 0.76）、种族（拉丁裔的OR = 0.35，95%CI = 0.23 - 0.54；亚裔的OR = 0.59，95%CI = 0.36 - 0.97；非裔美国人的OR = 0.47，95%CI = 0.29 - 0.75）以及较低的联邦贫困水平（联邦贫困线0 - 99%的OR = 1.89，95%CI = 1.35 - 2.63；联邦贫困线100 - 199%的OR = 1.65，95%CI = 1.27 - 2.14；联邦贫困线200 - 299%的OR = 1.39，95%CI = 1.12 - 1.72）均与COPD相关（P < 0.05）。年龄组、SPD、种族和就业与吸烟状态存在显著交互作用。按吸烟状态分层，在从不吸烟组中，年龄增长是COPD的唯一危险因素；而在吸烟组中，缺乏体育活动、年龄较大、SPD、种族、失业和较低的联邦贫困水平与COPD相关。
吸烟和年龄增长是COPD的主要危险因素，而在吸烟组中，缺乏体育活动和SPD与COPD密切相关。
