School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Hangkong Road 13, Wuhan 430030, China.
Huazhong University of Science and Technology Hospital, Luoyu Road 1037, Wuhan 430074, China.
Respir Med. 2017 Oct;131:158-165. doi: 10.1016/j.rmed.2017.08.018. Epub 2017 Aug 18.
Identifying risk factors is a key point for preventive strategies to reduce the incidence of COPD. The aim of this systematic review and meta-analysis was to determine the most important risk factors for COPD among adults in Chinese Mainland, so as to provide some precautions and interventions on this disease and preventing further recurrences.
A comprehensive literature review relating to risk factors for COPD through PubMed, EMBASE, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang database and VIP database was conducted before March 31, 2017. Odds ratio (OR) with 95% confidence interval (CI) was calculated after data combination to assess the associations between risk factors and COPD. Heterogeneity between the studies was assessed by I and Cochran's Q test. Egger's test was used to assess publication bias.
A total of 13893 participants (6383 cases and 7510 controls) from 19 case-controls studies were included. 12 risk factors with significant differences found between COPD and control groups were listed as follows: male sex (OR = 1.467; 95%CI: 1.097-1.962), smoking (OR = 2.092; 95%CI: 1.707-2.565), low educational level (OR = 1.609; 95%CI: 1.206-2.147), low BMI (OR = 3.831; 95%CI: 2.223-6.603), family history of respiratory disease (OR = 2.068; 95%CI: 1.466-2.918), allergy history (OR = 2.381; 95%CI: 1.385-4.093), respiratory infection during childhood (OR = 2.695; 95%CI: 1.504-4.828), recurrent respiratory infection (OR = 15.015; 95%CI: 4.538-49.684), occupational dust exposure (OR = 1.791; 95%CI: 1.151-2.788), biomass burning (OR = 2.218; 95%CI: 1.308-3.762), poor housing ventilation (OR = 3.993; 95%CI: 1.244-12.820), and living around polluted area (OR = 1.631; 95%CI: 1.202-2.214).
Twelve risk factors are associated with the occurrence of COPD in Chinese Mainland, which can be used to distinguish high-risk population. Health education and promotion campaigns should be designed in order to minimize or prevent the occurrence of COPD in Chinese Mainland.
识别风险因素是减少 COPD 发病率的预防策略的关键。本系统评价和荟萃分析的目的是确定中国大陆成年人 COPD 的最重要风险因素，以便为该疾病提供一些预防措施和干预措施，防止其进一步复发。
通过 PubMed、EMBASE、Cochrane 图书馆、中国知网（CNKI）、万方数据库和 VIP 数据库，对截至 2017 年 3 月 31 日有关 COPD 风险因素的文献进行全面综述。数据合并后计算比值比（OR）及其 95%置信区间（CI），以评估风险因素与 COPD 之间的相关性。采用 I ² 和 Cochran's Q 检验评估研究间的异质性。采用 Egger 检验评估发表偏倚。
共有 19 项病例对照研究的 13893 名参与者（6383 例病例和 7510 例对照）纳入本研究。列出了 COPD 组和对照组之间存在显著差异的 12 个风险因素：男性（OR=1.467；95%CI：1.097-1.962）、吸烟（OR=2.092；95%CI：1.707-2.565）、低教育水平（OR=1.609；95%CI：1.206-2.147）、低 BMI（OR=3.831；95%CI：2.223-6.603）、家族呼吸病史（OR=2.068；95%CI：1.466-2.918）、过敏史（OR=2.381；95%CI：1.385-4.093）、儿童期呼吸道感染（OR=2.695；95%CI：1.504-4.828）、反复呼吸道感染（OR=15.015；95%CI：4.538-49.684）、职业性粉尘暴露（OR=1.791；95%CI：1.151-2.788）、生物质燃烧（OR=2.218；95%CI：1.308-3.762）、住房通风不良（OR=3.993；95%CI：1.244-12.820）和居住在污染地区（OR=1.631；95%CI：1.202-2.214）。
12 个风险因素与中国大陆 COPD 的发生有关，可以用来区分高危人群。应设计健康教育和促进活动，以尽量减少或预防中国大陆 COPD 的发生。
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