尼泊尔慢性阻塞性肺疾病的相关因素：一项基于全国代表性人群的研究证据。
Factors Associated with Chronic Obstructive Pulmonary Diseases in Nepal: Evidence from a Nationally Representative Population-Based Study.
机构信息
Nepal Health Research Council (NHRC), Kathmandu, Nepal.
Department of Community Medicine, Maharajgunj Medical Campus, Kathmandu, Nepal.
出版信息
Int J Chron Obstruct Pulmon Dis. 2021 Apr 20;16:1109-1118. doi: 10.2147/COPD.S295321. eCollection 2021.
BACKGROUND
The Global Burden of Diseases Study 2017 predicted that chronic obstructive pulmonary disease (COPD) is the second leading cause of death, the fourth leading cause of premature death, and the third cause for DALYs lost in Nepal. However, data on the population-based prevalence of COPD in Nepal are very limited. This study aims to assess the prevalence of COPD and factors associated with the occurrence of COPD in Nepal.
METHODS
From a nationally representative, population-based cross-sectional study on chronic non-communicable diseases, the prevalence of COPD and its associated factors was determined. Of 12,557 participants aged over 20 years, 8945 participants completed a questionnaire and spirometry. Eligible participants were also asked to answer a COPD diagnostic questionnaire for screening COPD cases, and if needed underwent pre-bronchodilator and post-bronchodilator spirometry. COPD was defined as a post-bronchodilator FEV1/FVC (forced expiratory volume in 1 s/forced vital capacity) ratio of <0.70. Multivariate logistic regression was performed to identify factors associated with COPD. Sampling weights were used for all data analyses.
RESULTS
The prevalence of COPD in Nepal was 11.7% (95% CI: 10.5% to 12.9 %), which increased with age, and higher in those with a low educational level, those who had smoked ≥50 pack-years, persons having a low body mass index (BMI), and residents of Karnali province. Multivariate analysis revealed that being aged 60 years and above, having a low BMI, low educational status, having smoked more than 50 pack-years, provincial distribution, and ethnicity were independent predictors of COPD.
CONCLUSION
COPD is a growing and serious public health issue in Nepal. Factor such as old age, cigarette smoking, low educational attainment, low BMI, ethnicity, and locality of residence (province-level variation) plays a vital role in the occurrence of COPD. Strategies aimed at targeting these risk factors through health promotion and education interventions are needed to decrease the burden of COPD.
背景
2017 年全球疾病负担研究预测，慢性阻塞性肺疾病（COPD）是全球第二大致死原因、第四大致早死原因和尼泊尔第三大丧失伤残调整寿命年（DALY）原因。然而，尼泊尔 COPD 的人群患病率数据非常有限。本研究旨在评估尼泊尔 COPD 的患病率及其与 COPD 发生相关的因素。
方法
本研究来自于一项针对慢性非传染性疾病的全国代表性、人群为基础的横断面研究，确定了 COPD 的患病率及其相关因素。在年龄超过 20 岁的 12557 名参与者中，有 8945 名完成了问卷和肺量测定。符合条件的参与者还被要求回答 COPD 诊断问卷以筛查 COPD 病例，如果需要，则进行支气管扩张剂前和支气管扩张剂后肺量测定。COPD 定义为支气管扩张剂后 1 秒用力呼气量（FEV1）/用力肺活量（FVC）比<0.70。采用多变量逻辑回归确定与 COPD 相关的因素。所有数据分析均使用抽样权重。
结果
尼泊尔 COPD 的患病率为 11.7%（95%置信区间：10.5%至 12.9%），患病率随年龄增长而增加，且在受教育程度较低者、吸烟≥50 包年者、低体重指数（BMI）者和 Karnali 省居民中更高。多变量分析显示，60 岁及以上年龄、低 BMI、低教育程度、吸烟超过 50 包年、省级分布和种族是 COPD 的独立预测因素。
结论
COPD 是尼泊尔日益严重的公共卫生问题。年龄、吸烟、教育程度低、BMI 低、种族和居住地（省级差异）等因素在 COPD 的发生中起着重要作用。需要通过健康促进和教育干预措施针对这些危险因素制定策略，以减轻 COPD 的负担。
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