六个国家室内空气污染和吸烟对≥50岁人群哮喘的交互作用研究
|
摘要
目的探讨室内空气污染和吸烟之间的交互作用对≥50岁人群哮喘的影响,为哮喘的防控提供科学依据。方法随机抽取中国、加纳、印度、墨西哥、俄罗斯和南非6个中低收入国家的居民家庭户进行家庭问卷调查和对所有≥50岁的成员进行个人问卷调查。运用logistic回归模型分别分析室内空气污染(做饭燃料、烟囱设施)和吸烟(是否吸烟、吸烟频率、烟龄)与人群哮喘患病的关系,利用乘法模型和加法模型评价空气污染和吸烟对人群哮喘的交互作用影响。结果共有33 327名调查对象纳入分析,≥50岁人群哮喘的总患病率为3.89%(1 296/33 327)。调整国家、年龄、性别、婚姻状况、居住地、教育程度、体力活动、家庭收入等混杂因素后,吸烟人群相对于从不吸烟人群患哮喘风险增加(OR=1.18,95%CI:1.01～1.45);在不同吸烟频率的人群中,偶尔吸烟人群患哮喘的风险最高(OR=1.75,95%CI:1.33～2.30)。交互作用分析结果显示,除烟龄和做饭燃料外,室内空气污染和吸烟之间对≥50岁人群哮喘存在相加交互作用;是否吸烟(交互项OR=1.60,95%CI:1.26～2.02)、吸烟频率(交互项OR=1.61,95%CI:1.28～2.04)、吸烟烟龄(交互项OR=1.69,95%CI:1.39～2.21)均与做饭燃料之间在≥50岁人群哮喘患病风险中存在相乘交互作用。当2种危险因素同时存在时,患哮喘的风险最高。吸烟和做饭燃料为柴/煤/炭人群患哮喘的风险是不吸烟和燃料为电/燃气的1.43倍(95%CI:1.17～1.75)。结论室内空气污染和吸烟均与≥50岁人群哮喘患病有关,并对≥50岁人群哮喘患病存在交互作用。
Objective To investigate the effect of interaction between indoor air pollution and smoking on senile asthma. Methods Households in six lowand middleincome countries:China,Ghana,India,Mexico,Russia,and South Africa,were randomly selected for household surveys,and individual questionnaires were conducted among all members aged 50 years and older. Logistic regression models were used to analyze the relationship between indoor air pollution(cooking fuel,chimney facilities),smoking(smoking status,smoking frequency,smoking duration),and senile asthma. Multiplication and addition models were used to assess the effects of interaction between air pollution and smoking on senile asthma. Results A total of 33 327 respondents were included in the analysis,and the overall prevalence of senile asthma in six countries was 3.89%(1 296/33 327). After adjusting for confounding factors of country,age,gender,marital status,place of residence,education level,physical activity,and family income,the risk of asthma increased among smokers compared with that of nonsmokers(OR=1.18,95%CI:1.01-1.45);among the participants with different smoking frequencies,those who smoked occasionally had the highest risk of asthma(OR=1.75,95% CI:1.33-2.30). The interaction analysis showed that besides smoking duration and cooking fuel,there was additive interaction between indoor air pollution and smoking on senile asthma;multiplier interactions between smoking status(interaction OR=1.60,95%CI:1.26-2.02),smoking frequency(interaction OR=1.61,95% CI:1.28-2.04),smoking duration(interaction OR=1.69,95% CI:1.39-2.21)and cooking fuel were found to be correlated with the risk of asthma in the elderly. The risk of asthma was highest when two risk factors coexisted. The risk of asthma in smokers using firewood/coal/charcoal as cooking fuel was 1.43 times higher than that of nonsmokers using the electricity/gas as cooking fuel(95% CI:1.17-1.75). Conclusion Both indoor air pollution and smoking were associated and interacted with senile asthma.
Objective To investigate the effect of interaction between indoor air pollution and smoking on senile asthma. Methods Households in six lowand middleincome countries:China,Ghana,India,Mexico,Russia,and South Africa,were randomly selected for household surveys,and individual questionnaires were conducted among all members aged 50 years and older. Logistic regression models were used to analyze the relationship between indoor air pollution(cooking fuel,chimney facilities),smoking(smoking status,smoking frequency,smoking duration),and senile asthma. Multiplication and addition models were used to assess the effects of interaction between air pollution and smoking on senile asthma. Results A total of 33 327 respondents were included in the analysis,and the overall prevalence of senile asthma in six countries was 3.89%(1 296/33 327). After adjusting for confounding factors of country,age,gender,marital status,place of residence,education level,physical activity,and family income,the risk of asthma increased among smokers compared with that of nonsmokers(OR=1.18,95%CI:1.01-1.45);among the participants with different smoking frequencies,those who smoked occasionally had the highest risk of asthma(OR=1.75,95% CI:1.33-2.30). The interaction analysis showed that besides smoking duration and cooking fuel,there was additive interaction between indoor air pollution and smoking on senile asthma;multiplier interactions between smoking status(interaction OR=1.60,95%CI:1.26-2.02),smoking frequency(interaction OR=1.61,95% CI:1.28-2.04),smoking duration(interaction OR=1.69,95% CI:1.39-2.21)and cooking fuel were found to be correlated with the risk of asthma in the elderly. The risk of asthma was highest when two risk factors coexisted. The risk of asthma in smokers using firewood/coal/charcoal as cooking fuel was 1.43 times higher than that of nonsmokers using the electricity/gas as cooking fuel(95% CI:1.17-1.75). Conclusion Both indoor air pollution and smoking were associated and interacted with senile asthma.
引文
[1] World Health Organization. Topical overview:asthma[EB/OL].[2018-07-10]. http://www.who.int/en/news-room/fact-sheets/detail/asthma.
[2] Litonjua AA. Vitamin D deficiency as a risk factor for childhood allergic disease and asthma[J]. Curr Opin Allergy Clin Immunol,2012,12(2):179-185.
[3] Luo L,Ren J,Zhang F,et al. The effects of air pollution on length of hospital stay for adult patients with asthma[J]. Int J Health Plann Manage,2018,33(3):e751-e767.
[4] Jacquemin B,Siroux V,Sanchez M,et al. Ambient Air Pollution and Adult Asthma Incidence in Six European Cohorts(ESCAPE)[J]. Environ Health Persp,2015,123(6):613-621.
[5] To T,Shen S,Atenafu EG,et al. The air quality health index and asthma morbidity:a populationbased study[J]. Environ Health Persp,2013,121(1):46-52.
[6] Nachman KE,Parker JD. Exposures to fine particulate air pollution and respiratory outcomes in adults using two national datasets:across-sectionalstudy[J].EnvironHealth,2012,11(1):25-36.
[7] Kunzli N,Bridevaux P,Liu LS,et al. Trafficrelated air pollution correlates with adultonset asthma among neversmokers[J].Thorax,2009,64(8):664-670.
[8]吴家刚,何启强,杜琳,等.空气污染与广州市儿童呼吸系统健康关联的横断面研究[J].华南预防医学,2012,38(1):1-5.
[9] Klepeis NE,Nelson WC,Ott WR,et al. The National Human Activity Pattern Survey(NHAPS):a resource for assessing exposure to environmental pollutants[J]. J Expo Anal Environ Epidemiol,2001,11(3):231-252.
[10]王宁,丛舒,方利文,等.我国成人吸烟、二手烟暴露与哮喘患病的关系[J].中国健康教育,2016,32(10):867-870.
[11] Nguyen KH,King BA,Dube SR. Association between current asthma and secondhand smoke exposure in vehicles among adults living in four US states[J]. Tob Control,2015,24(4):376-381.
[12]苏楠,林江涛,刘国梁,等.我国8省市支气管哮喘患者控制水平的流行病学调查[J].中华内科杂志,2014,53(8):601-606.
[13] Kowal P,Chatterji S,Naidoo N,et al. Data resource profile:the World Health Organization study on global ageing and adult health(SAGE)[J]. Int J Epidemiol,2012,41(6):1639-1649.
[14] Wu F,Guo Y,Kowal P,et al. Prevalence of major chronic conditions among older Chinese adults:the study on global ageing and adult health(SAGE)wave 1[J]. PLoS ONE,2013,8(9):e74176.
[15]樊萌语,吕筠,何平平.国际体力活动问卷中体力活动水平的计算方法[J].中华流行病学杂志,2014,35(8):961-964.
[16] Knol MJ,Vanderweele TJ,Groenwold RHH,et al. Estimating measures of interaction on an additive scale for preventive exposures[J]. Eur J Epidemiol,2011,26(6):433-438.
[17] GlobalInitiativeforAsthma.Globalstrategyforasthmamanagement andprevention[EB/OL].[2018-08-05].http/:/www.ginasthma.org.
[18] International Union Against Tuberculosis and Lung Disease. The global burden of asthma,2014[EB/OL].[2018-08-03].http://www.globalasthmareport.org/burden/burden.php.
[19] Sonomjamts M,Dashdemberel S,Logii N,et al. Prevalence of asthma and allergic rhinitis among adult population in Ulaanbaatar,Mongolia[J]. Asia Pac Allergy,2014,4(1):25-31.
[20]王文雅,林江涛,苏楠,等. 2010—2011年北京地区14岁以上人群支气管哮喘患病率调查[J].中华医学杂志,2013,93(18):1383-1387.
[21]李继鹏.昆明地区人群哮喘患病情况及相关危险因素的流行病学调查[J].临床肺科杂志,2015,20(9):1667-1669.
[22] Nafti S,Taright S,EI FM,et al. Prevalence of asthma in North Africa:the Asthma Insights and Reality in the Maghreb(AIRMAG)study[J]. Respir Med,2009,103(Suppl 2):S2-S11.
[23] Martinez FD,Wright AL,Taussig LM,et al. Asthma and wheezing in the first six years of life. The Group Health Medical Associates[J]. N Engl J Med,1995,332(3):133-138.
[24] Pellegrino R. Interpretative strategies for lung function tests[J].Eur Respir J,2005,26(5):948-968.
[25] JieY,IsmailNH,JieX,etal.Doindoorenvironmentsinfluenceasthmaandasthmarelatedsymptomsamongadultsinhomes? A review oftheliterature[J].JFormosMedAssoc,2011,110(9):555-563.
[26] Barry AC,Mannino DM,Hopenhayn C,et al. Exposure to indoor biomass fuel pollutants and asthma prevalence in Southeastern Kentucky:results from the Burden of Lung Disease(BOLD)study[J]. J Asthma,2010,47(7):735-741.
[27] Trevor J,Antony V,Jindal SK. The effect of biomass fuel exposure on the prevalence of asthma in adults in Indiareview of current evidence[J]. J Asthma,2013,51(2):136-141.
[28]农英,林江涛,陈萍,等.我国14岁以上人群吸烟状况及其与支气管哮喘发病和控制的关系[J].中华内科杂志,2017,56(7):485-489.
[29] SilvermanRA,HasegawaK,EganDJ,etal.Multicenterstudyofcigarettesmokingamongadultswithasthmaexacerbationsintheemergencydepartment,2011-2012[J].RespirMed,2017,125(4):89-91.
[30]西艾木西卡买尔·艾合买提,玛丽叶古·阿吾提,刘晖,等.新疆维吾尔族成人支气管哮喘的影响因素研究[J].现代预防医学,2016,43(3):542-545.
[31] Ahlbom A,Alfredsson L. Interaction:a word with two meanings creates confusion[J]. Eur J Epidemiol,2005,20(7):563-564.
[32]许敏锐,强德仁,周义红,等.应用R软件进行logistic回归模型的交互作用分析[J].中国卫生统计,2017,34(4):670-672.
[2] Litonjua AA. Vitamin D deficiency as a risk factor for childhood allergic disease and asthma[J]. Curr Opin Allergy Clin Immunol,2012,12(2):179-185.
[3] Luo L,Ren J,Zhang F,et al. The effects of air pollution on length of hospital stay for adult patients with asthma[J]. Int J Health Plann Manage,2018,33(3):e751-e767.
[4] Jacquemin B,Siroux V,Sanchez M,et al. Ambient Air Pollution and Adult Asthma Incidence in Six European Cohorts(ESCAPE)[J]. Environ Health Persp,2015,123(6):613-621.
[5] To T,Shen S,Atenafu EG,et al. The air quality health index and asthma morbidity:a populationbased study[J]. Environ Health Persp,2013,121(1):46-52.
[6] Nachman KE,Parker JD. Exposures to fine particulate air pollution and respiratory outcomes in adults using two national datasets:across-sectionalstudy[J].EnvironHealth,2012,11(1):25-36.
[7] Kunzli N,Bridevaux P,Liu LS,et al. Trafficrelated air pollution correlates with adultonset asthma among neversmokers[J].Thorax,2009,64(8):664-670.
[8]吴家刚,何启强,杜琳,等.空气污染与广州市儿童呼吸系统健康关联的横断面研究[J].华南预防医学,2012,38(1):1-5.
[9] Klepeis NE,Nelson WC,Ott WR,et al. The National Human Activity Pattern Survey(NHAPS):a resource for assessing exposure to environmental pollutants[J]. J Expo Anal Environ Epidemiol,2001,11(3):231-252.
[10]王宁,丛舒,方利文,等.我国成人吸烟、二手烟暴露与哮喘患病的关系[J].中国健康教育,2016,32(10):867-870.
[11] Nguyen KH,King BA,Dube SR. Association between current asthma and secondhand smoke exposure in vehicles among adults living in four US states[J]. Tob Control,2015,24(4):376-381.
[12]苏楠,林江涛,刘国梁,等.我国8省市支气管哮喘患者控制水平的流行病学调查[J].中华内科杂志,2014,53(8):601-606.
[13] Kowal P,Chatterji S,Naidoo N,et al. Data resource profile:the World Health Organization study on global ageing and adult health(SAGE)[J]. Int J Epidemiol,2012,41(6):1639-1649.
[14] Wu F,Guo Y,Kowal P,et al. Prevalence of major chronic conditions among older Chinese adults:the study on global ageing and adult health(SAGE)wave 1[J]. PLoS ONE,2013,8(9):e74176.
[15]樊萌语,吕筠,何平平.国际体力活动问卷中体力活动水平的计算方法[J].中华流行病学杂志,2014,35(8):961-964.
[16] Knol MJ,Vanderweele TJ,Groenwold RHH,et al. Estimating measures of interaction on an additive scale for preventive exposures[J]. Eur J Epidemiol,2011,26(6):433-438.
[17] GlobalInitiativeforAsthma.Globalstrategyforasthmamanagement andprevention[EB/OL].[2018-08-05].http/:/www.ginasthma.org.
[18] International Union Against Tuberculosis and Lung Disease. The global burden of asthma,2014[EB/OL].[2018-08-03].http://www.globalasthmareport.org/burden/burden.php.
[19] Sonomjamts M,Dashdemberel S,Logii N,et al. Prevalence of asthma and allergic rhinitis among adult population in Ulaanbaatar,Mongolia[J]. Asia Pac Allergy,2014,4(1):25-31.
[20]王文雅,林江涛,苏楠,等. 2010—2011年北京地区14岁以上人群支气管哮喘患病率调查[J].中华医学杂志,2013,93(18):1383-1387.
[21]李继鹏.昆明地区人群哮喘患病情况及相关危险因素的流行病学调查[J].临床肺科杂志,2015,20(9):1667-1669.
[22] Nafti S,Taright S,EI FM,et al. Prevalence of asthma in North Africa:the Asthma Insights and Reality in the Maghreb(AIRMAG)study[J]. Respir Med,2009,103(Suppl 2):S2-S11.
[23] Martinez FD,Wright AL,Taussig LM,et al. Asthma and wheezing in the first six years of life. The Group Health Medical Associates[J]. N Engl J Med,1995,332(3):133-138.
[24] Pellegrino R. Interpretative strategies for lung function tests[J].Eur Respir J,2005,26(5):948-968.
[25] JieY,IsmailNH,JieX,etal.Doindoorenvironmentsinfluenceasthmaandasthmarelatedsymptomsamongadultsinhomes? A review oftheliterature[J].JFormosMedAssoc,2011,110(9):555-563.
[26] Barry AC,Mannino DM,Hopenhayn C,et al. Exposure to indoor biomass fuel pollutants and asthma prevalence in Southeastern Kentucky:results from the Burden of Lung Disease(BOLD)study[J]. J Asthma,2010,47(7):735-741.
[27] Trevor J,Antony V,Jindal SK. The effect of biomass fuel exposure on the prevalence of asthma in adults in Indiareview of current evidence[J]. J Asthma,2013,51(2):136-141.
[28]农英,林江涛,陈萍,等.我国14岁以上人群吸烟状况及其与支气管哮喘发病和控制的关系[J].中华内科杂志,2017,56(7):485-489.
[29] SilvermanRA,HasegawaK,EganDJ,etal.Multicenterstudyofcigarettesmokingamongadultswithasthmaexacerbationsintheemergencydepartment,2011-2012[J].RespirMed,2017,125(4):89-91.
[30]西艾木西卡买尔·艾合买提,玛丽叶古·阿吾提,刘晖,等.新疆维吾尔族成人支气管哮喘的影响因素研究[J].现代预防医学,2016,43(3):542-545.
[31] Ahlbom A,Alfredsson L. Interaction:a word with two meanings creates confusion[J]. Eur J Epidemiol,2005,20(7):563-564.
[32]许敏锐,强德仁,周义红,等.应用R软件进行logistic回归模型的交互作用分析[J].中国卫生统计,2017,34(4):670-672.