中国成年人气流受限与慢性病主要死亡风险的前瞻性研究

摘要

Objective To examine the prospective associations between airflow obstruction and total and cause-specific mortality.Methods The study was based on China Kadoorie Biobartk,in which 199 099 men and 287 895 women aged 30-79 years at baseline survey were included after excluding those with heart disease,stroke and cancer.The Global Initiative on Obstructive Lung Disease (GOLD) guideline was used to classify airflow obstruction.Cox regression models were used to estimate adjusted HR and 95％CI.Results During 3 494 079 person-years of follow-up between 2004 and 2013 (median 7.2 years),a total of 21 649 people died.Absolute mortality rates were 5.5,9.9,13.1,32.4 and 63.3 deaths per 1 000 person-years for participants who had normal airflow,GOLD-1 to GOLD-4 airflow obstruction,respectively.After adjusting potential confounders,compared with participants with normal lung function,the HRs for death were 0.98 (95％CI:0.88-1.09),1.03 (95％CI:0.97-1.09),1.62 (95％CI:1.53-1.73) and 2.83 (95％CI:2.59-3.10) for those whose airflow obstruction were classified as GOLD-1 to GOLD-4,respectively.The airflow obstruction was also associated with increased risk for deaths due to ischemic heart disease,cerebrovascular disease and chronic obstructive pulmonary disease.Conclusion Airflow obstruction is associated with total and certain cause-specific mortality,the higher the airflow obstruction degree is,the higher the death risk is.%目的 探讨气流受限与慢性病总死亡和死因别死亡风险间的关联性.方法 基于中国慢性病前瞻性研究项目,剔除基线自报患有心脏病、脑卒中和恶性肿瘤的个体,共纳入基线时项目地区30 ～ 79岁的男女性研究对象各199 099和287 895例.气流受限情况采用COPD全球倡议标准(GOLD)判断.使用Cox比例风险回归模型分析气流受限与死亡之间的关联.结果 平均随访7.2年,累计随访3 494 079人年.21 649例在随访期间死亡.气流正常、GOLD-1～GOLD-4等级的全人群粗死亡率(/1 000人年)分别为5.5、9.9、13.1、32.4和63.3.调整可能的混杂因素后,与气流正常人群相比,GOLD-1～GOLD-4的HR值(95％CI)依次为0.98(0.88～ 1.09)、1.03(0.97～ 1.09)、1.62(1.53～1.73)和2.83(2.59 ～3.10).气流受限等级上升,缺血性心脏病、脑血管病和COPD的死亡风险也上升.结论 存在气流受限或气流受限程度越严重,个体发生死亡的风险越高.