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上海嘉定区 COPD 死亡率的地理差异及其相关危险因素

Geographical Variation of COPD Mortality and Related Risk Factors in Jiading District, Shanghai.

机构信息

Jiading District Center for Disease Control and Prevention, Shanghai, China.

Fudan University School of Public Health, Shanghai, China.

出版信息

Front Public Health. 2021 Feb 3;9:627312. doi: 10.3389/fpubh.2021.627312. eCollection 2021.

Abstract

Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death in China. Although numerous studies have been conducted to determine the risk factors for COPD mortality such as ambient air pollution, the results are not fully consistent. This study included mortality analysis and a case-control design by using the data extracted from the Mortality Registration System in Jiading District, Shanghai. Traditional logistic regression, geographically weighted logistic regression (GWLR), and spatial scan statistical analysis were performed to explore the geographic variation of COPD mortality and the possible influencing factors. Traditional logistic regression showed that extreme lower temperature in the month prior to death, shorter distance to highway, lower GDP level were associated with increased COPD mortality. GWRL model further demonstrated obvious geographical discrepancies for the above associations. We additionally identified a significant cluster of low COPD mortality (OR = 0.36, = 0.002) in the southwest region of Jiading District with a radius of 3.55 km by using the Bernoulli model. The geographical variation in age-standardized mortality rate for COPD in Jiading District was explained to a certain degree by these factors. The risk of COPD mortality in Jiading District showed obvious geographical variation, which were partially explained by the geographical variations in effects of the extreme low temperature in the month prior to death, residential proximity to highway, and GDP level.

摘要

慢性阻塞性肺疾病(COPD)是中国的第四大死亡原因。尽管已经有许多研究致力于确定 COPD 死亡率的危险因素,如环境空气污染,但结果并不完全一致。本研究通过使用从上海市嘉定区死因登记系统中提取的数据,进行了死亡率分析和病例对照设计。采用传统的逻辑回归、地理加权逻辑回归(GWLR)和空间扫描统计分析方法,探讨了 COPD 死亡率的地理变化及其可能的影响因素。传统的逻辑回归显示,死亡前一个月的极端低温、与高速公路的距离较短以及较低的 GDP 水平与 COPD 死亡率的增加有关。GWRL 模型进一步表明,上述关联存在明显的地理差异。我们还通过 Bernoulli 模型,在嘉定区西南部发现了一个 COPD 死亡率显著较低的显著集群(OR = 0.36, = 0.002),半径为 3.55 公里。嘉定区 COPD 年龄标准化死亡率的地理变化在一定程度上可以用这些因素来解释。嘉定区 COPD 死亡率的风险呈现出明显的地理差异,这部分可以用死亡前一个月的极端低温、居住与高速公路的接近程度以及 GDP 水平的地理变化来解释。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1e5a/7888271/cf12d18cc407/fpubh-09-627312-g0001.jpg

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