Li Zhiwei, Lu Feng, Liu Mengmeng, Guo Moning, Tao Lixin, Wang Tianqi, Liu Mengyang, Guo Xiuhua, Liu Xiangtong
School of Public Health Capital Medical University Beijing China.
Beijing Municipal Key Laboratory of Clinical Epidemiology Beijing China.
Geohealth. 2023 Mar 27;7(3):e2022GH000734. doi: 10.1029/2022GH000734. eCollection 2023 Mar.
The association between CO and chronic obstructive pulmonary disease (COPD) has been widely reported; however, the association among patients with type 2 diabetes mellitus (T2DM) or hypertension has remained largely unknown in China. Over-dispersed generalized additive model was adopted to quantity the associations between CO and COPD with T2DM or hypertension. Based on principal diagnosis, COPD cases were identified according to the International Classification of Diseases (J44), and a history of T2DM and hypertension was coded as E12 and I10-15, O10-15, P29, respectively. A total of 459,258 COPD cases were recorded from 2014 to 2019. Each interquartile range uptick in CO at lag 03 corresponded to 0.21% (95%CI: 0.08%-0.34%), 0.39% (95%CI: 0.13%-0.65%), 0.29% (95%CI: 0.13%-0.45%) and 0.27% (95%CI: 0.12%-0.43%) increment in admissions for COPD, COPD with T2DM, COPD with hypertension and COPD with both T2DM and hypertension, respectively. The effects of CO on COPD with T2DM ( = 0.77, = 0.444), COPD with hypertension ( = 0.19, = 0.234) and COPD with T2DM and hypertension ( = 0.61, = 0.543) were insignificantly higher than that on COPD. Stratification analysis showed that females were more vulnerable than males except for T2DM group (COPD: = 3.49, < 0.001; COPD with T2DM: = 0.176, = 0.079; COPD with hypertension: = 2.48, = 0.013; COPD with both T2DM and hypertension: = 2.44, = 0.014); No statistically significant difference could be found between age groups (COPD: = 1.63, = 0.104; COPD with T2DM: = 0.23, = 0.821; COPD with hypertension: = 0.53, = 0.595; COPD with both T2DM and hypertension: = 0.71, = 0.476); Higher effects appeared in cold seasons than warm seasons on COPD ( = 0.320, < 0.001). This study demonstrated an increased risk of COPD with comorbidities related to CO exposure in Beijing. We further provided important information on lag patterns, susceptible subgroups, and sensitive seasons, as well as the characteristics of the exposure-response curves.
一氧化碳（CO）与慢性阻塞性肺疾病（COPD）之间的关联已被广泛报道；然而，在中国，2型糖尿病（T2DM）或高血压患者中二者的关联在很大程度上仍不为人知。采用过度分散广义相加模型来量化CO与COPD合并T2DM或高血压之间的关联。基于主要诊断，根据国际疾病分类（J44）确定COPD病例，T2DM和高血压病史分别编码为E12和I10 - 15、O10 - 15、P29。2014年至2019年共记录了459,258例COPD病例。在滞后03时，CO每升高一个四分位间距，COPD、COPD合并T2DM、COPD合并高血压以及COPD合并T2DM和高血压的住院人数分别增加0.21%（95%CI：0.08% - 0.34%）、0.39%（95%CI：0.13% - 0.65%）、0.29%（95%CI：0.13% - 0.45%）和0.27%（95%CI：0.12% - 0.43%）。CO对COPD合并T2DM（β = 0.77，P = 0.444）、COPD合并高血压（β = 0.19，P = 0.234）以及COPD合并T2DM和高血压（β = 0.61，P = 0.543）的影响略高于对单纯COPD的影响，但无统计学意义。分层分析表明，除T2DM组外，女性比男性更易患病（COPD：β = 3.49，P < 0.001；COPD合并T2DM：β = 0.176，P = 0.079；COPD合并高血压：β = 2.48，P = 0.013；COPD合并T2DM和高血压：β = 2.44，P = 0.014）；各年龄组之间无统计学显著差异（COPD：β = 1.63，P = 0.104；COPD合并T2DM：β = 0.23，P = 0.821；COPD合并高血压：β = 0.53，P = 0.595；COPD合并T2DM和高血压：β = 0.71，P = 0.476）；寒冷季节CO对COPD的影响高于温暖季节（β = 0.320，P < 0.001）。本研究表明，在北京，CO暴露相关合并症会增加患COPD的风险。我们进一步提供了关于滞后模式、易感亚组、敏感季节以及暴露 - 反应曲线特征的重要信息。
