The State Key Lab of Respiratory Disease, The First Affiliated Hospital, Institute of Public Health, Guangzhou Medical University, Guangzhou, China.
Department of Pulmonary and Critical Care Medicine, Quzhou People's Hospital, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou, China.
Front Public Health. 2023 Mar 2;11:1127566. doi: 10.3389/fpubh.2023.1127566. eCollection 2023.
Chronic Obstructive Pulmonary Disease (COPD) is a common and harmful disease that requires an effective tool to early screen high-risk individuals. Gansu has unique environments and customs, leading to the different prevalence and etiology of COPD from other regions. The association between altitude and COPD once attracted epidemiologists' attention. However, the prevalence in Gansu and the role of altitude are still unclarified.
In Gansu, a multistage stratified cluster sampling procedure was utilized to select a representative sample aged 40 years or older. The questionnaire and spirometry examination were implemented to collect participants' information. The diagnosis and assessment of COPD were identified by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criterion, while post-bronchodilator FEV/FVC < LLN was for sensitivity analysis. Furthermore, the effect of high altitude on COPD was evaluated by the logistic regression model after propensity score matching (PSM). Finally, the participants were randomly divided into training and validation sets. The training set was used to screen the relative factors and construct a nomogram which was further assessed by the receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA) in the two sets.
There were 2,486 eligible participants in the final analysis, of which 1,584 lived in low altitudes and 902 lived in high altitudes. Based on the GOLD criterion, the crude and standardized prevalences in Gansu were 20.4% (18.7-22.0) and 19.7% (17.9-21.6). After PSM, the logistic regression model indicated that high altitude increased COPD risk [PSM OR: 1.516 (1.162-1.978)]. Altitude, age, sex, history of tuberculosis, coal as fuel, and smoking status were reserved for developing a nomogram that demonstrated excellent discrimination, calibration, and clinical benefit in the two sets.
COPD has become a serious public health problem in Gansu. High altitude is a risk factor for COPD. The nomogram has satisfactory efficiency in screening high-risk individuals.
慢性阻塞性肺疾病（COPD）是一种常见且危害严重的疾病，需要一种有效的工具来早期筛选高危人群。甘肃有其独特的环境和习俗，导致 COPD 的患病率和病因与其他地区不同。海拔与 COPD 的关系曾引起流行病学家的关注。然而，甘肃的 COPD 患病率和海拔的作用尚不清楚。
在甘肃，采用多阶段分层聚类抽样程序选择了一个具有代表性的 40 岁及以上年龄的样本。通过问卷调查和肺功能检查收集参与者的信息。采用全球慢性阻塞性肺疾病倡议（GOLD）标准诊断和评估 COPD，而支气管扩张剂后 FEV/FVC<LLN 则用于敏感性分析。此外，采用逻辑回归模型在倾向评分匹配（PSM）后评估高海拔对 COPD 的影响。最后，将参与者随机分为训练集和验证集。在两个集合中，使用训练集筛选出相对因素并构建列线图，然后使用接收者操作特征（ROC）曲线、校准曲线和决策曲线分析（DCA）进行评估。
最终分析共纳入 2486 名符合条件的参与者，其中 1584 名居住在低海拔地区，902 名居住在高海拔地区。根据 GOLD 标准，甘肃的粗患病率和标准化患病率分别为 20.4%（18.7-22.0）和 19.7%（17.9-21.6）。PSM 后，逻辑回归模型表明高海拔增加了 COPD 风险[PSM OR：1.516（1.162-1.978）]。保留海拔、年龄、性别、结核病史、煤作为燃料和吸烟状况用于开发列线图，该列线图在两个集合中均表现出良好的区分度、校准度和临床获益。
COPD 已成为甘肃严重的公共卫生问题。高海拔是 COPD 的一个危险因素。该列线图在筛选高危人群方面具有令人满意的效率。
