上海市闵行区老年人群慢性阻塞性肺疾病患病率及影响因素分析

Prevalence and related risk factors of chronic obstructive pulmonary disease in community-dwelling elderly in Shanghai Minhang district

关键词:  老年人群  慢性阻塞性肺疾病  问卷筛查  便携式肺功能仪  危险因素

Key words:  elderly people  chronic obstructive pulmonary disease  questionnaire screening  portable lung function instrument  risk factors

摘要:

目的 了解上海市闵行区老年人群慢性阻塞性肺疾病患病率及患病相关危险因素。方法 以2021年1月—2022年12月在上海市闵行区新虹街道及莘庄镇参加60岁以上免费体检的人群作为研究对象，使用慢性阻塞性肺疾病人群筛查问卷（chronic obstructive pulmonary disease population screener questionnaire, COPD-PS）对老年人群进行评分，同时收集人群的一般资料，用便携式肺功能仪器检测肺功能，按照慢性阻塞性肺疾病的诊断标准进行诊断，采用Logistic回归模型分析闵行区老年人群患慢性阻塞性肺疾病的相关危险因素。将COPD-PS评分与第1秒用力呼气的容积占预计值的百分比（percentage of predicted forced expiratory volume in one second, FEV1%pred）联合诊断行受试者工作特征曲线分析。结果 共有935例60岁及以上居民参与了本项研究，其中有236例被诊断为慢性阻塞性肺疾病，该地区老年人群的慢性阻塞性肺疾病的患病率为25.24%，其中男性患病率为35.86%，女性为13.65%。慢性阻塞性肺疾病在老年人群的知晓率为6.2%。年龄、性别、BMI、吸烟史、COPD-PS问卷分数、受教育程度、家庭年经济收入、家庭烹饪频率、慢性阻塞性肺疾病家族史、呼吸系统疾病史、职业暴露史、肺炎疫苗接种史等指标与老年人群患慢性阻塞性肺疾病相关（P<0.05）。多因素Logistic回归分析结果显示，慢性阻塞性肺疾病患病的独立危险因素有: 年龄、吸烟史、COPD-PS筛查问卷分数，OR值分别是1.052（1.0171.089）、10.956（5.58921.476）、2.414（2.0502.844）。女性、较高的BMI和有肺炎疫苗接种史是保护因素，（P<0.05），其对应的OR值分别是0.252（0.1230.518）、0.934（0.8770.995）和0.199（0.0060.066）。COPD-PS问卷评分为4分时为最佳截断值，ROC曲线下面积AUC=0.839，（95%CI: 0.8120.866，P<0.05）。COPD-PS问卷分数联合FEV1%pred诊断，AUC=0.894（P<0.05，95%CI: 0.8720.916），对老年人群患慢性阻塞性肺疾病有预测价值。结论 上海市闵行区老年人群慢性阻塞性肺疾病知晓效率低而患病率高。年龄、性别、BMI、吸烟、COPD-PS问卷分数、肺炎疫苗接种史等因素与闵行区老年人群患慢性阻塞性肺疾病有关。COPD-PS问卷联合便携式肺功能仪有助于在社区早期发现及诊断慢性阻塞性肺疾病，有高危风险的人群应尽早完善肺功能检测。

Abstract:

Objective To investigate the prevalence of chronic obstructive pulmonary disease(COPD) and related risk factors among community-dwelling elderly in Shanghai Minhang district. Methods Residents over 60 years old who underwent free physical examination in two community health service centers of Shanghai Minhang district from January 2021 to December 2022 were enrolled in the study. The Chronic Obstructive Pulmonary Disease Population Screening questionnaire(COPD-PS) was used for the survey, and general information of participants was collected. The lung function were measured with a portable pulmonary function instrument, and the diagnosis was made according to the diagnostic criteria of COPD. The risk factors related to COPD were analyzed by Logistic regression model. The diagnostic value of COPD-PS score combined with FEV1%pred of pulmonary function for COPE was evaluated with ROC curve. Results A total of 935 residents aged 60 years and above participated in the study, of whom 236 were diagnosed as COPD with a prevalence rate of 25.24%, 35.86% for males and 13.65% for females. The awareness rate of COPD was 6.2%. Age, sex, BMI, smoking history, COPD-PS questionnaire score, education level, family annual economic income, family cooking frequency, family history of COPD, history of respiratory disease, occupational exposure, pneumonia vaccination and other indicators were associated with COPD(all P<0.05). Multivariate Logistic regression analysis showed that age(OR=1.052, 95%CI: 1.017-1.089), smoking history(OR=10.956, 95%CI: 5.589-21.476) and COPD-PS score(OR=2.414, 95%CI: 2.050-2.844) were independent risk factors for COPD(all P<0.05); and female gender(OR=0.252, 95%CI: 0.123 to 0.518), higher BMI(OR=0.934, 95%CI: 0.877 to 0.995) and history of pneumonia vaccination(OR=0.199, 95%CI: 0.006 to 0.066) were protective factors(all P<0.05). The area under ROC curve(AUC) of COPD-PS questionnaire score for diagnosis of COPD was 0.839(95%CI 0.812-0.866, P<0.05), while that of COPD-PS score plus FEV1%pred was 0.894(95%CI: 0.872-0.916, P<0.05）. Conclusion This study shows that the elderly people in the study community of Shanghai Minhang district has low awareness and high prevalence of COPD. Age, sex, BMI, smoking, COPD-PS questionnaire score, pneumonia vaccination history and other factors are associated with risk of COPD. COPD-PS questionnaire combined with pulmonary function measurement can help early detection and diagnosis of COPD in the community.