Chronic Obstructive Pulmonary Disease-Associated Mortality — China, 2014–2021

Zifang Zhou¹; Lijun Wang¹; Maigeng Zhou¹; Peng Yin^1#

¹ National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.

^# Corresponding author: Peng Yin, yinpeng@ncncd.chinacdc.cn.

Chronic obstructive pulmonary disease (COPD) had brought severe public-health burden to China. Previous mortality estimation was mainly based on underlying cause of death. This study analyzed COPD-associated death and its comorbidities using all COPD cases on the chain of events on the death certificate and estimated the average annual percentage change (AAPC) from 2014 to 2021. During the study period, age-standardized mortality rate of COPD decreased from 91.84 to 45.90 per 100,000 population. Significant but uneven decrease in COPD mortality were observed across gender, regions and residential areas. Besides, COPD was found coexisting with a broad set of disease with cardiovascular diseases (CVDs) and respiratory events being the two leading ones. To prevent and manage COPD, it is essential to implement tailored prevention and intervention strategies based on local context. Special attention should be given to individuals diagnosed with CVDs and other respiratory conditions to prevent the initiation of COPD.

慢性阻塞性肺病相关死亡分析 — 中国，2014–2021年

周梓芳¹；王黎君¹；周脉耕¹；殷鹏^1#

1 中国疾病预防控制中心慢性非传染性疾病预防控制中心，北京，中国。

^# 通信作者：殷鹏，yinpeng@ncncd.chinacdc.cn。

慢性阻塞性肺病（慢阻肺）给中国带来沉重的负担。既往研究对慢阻肺死亡估计往往基于根本死因。本研究提取了死因链上涉及慢阻肺的所有个案，并以此为基础估计慢阻肺相关的死亡及其共病情况，并以平均年度变化率（AAPC）为指标分析2014-2021年间的变化趋势。在研究期间，慢阻肺标化死亡率从91.84/10万下降至45.90/10万。不同性别、区域及城乡间，慢阻肺标化死亡率均呈下降趋势，但降幅差异显著。此外，慢阻肺与其他疾病共存的现象非常普遍，心血管及呼吸系统相关疾病是慢阻肺患者死亡时两大类主要共存疾病。因此，为实现对慢阻肺的全面预防和控制、提升我国整体健康水平，应因地制宜地实施个性化的预防和干预措施，并重点关注已确诊心血管疾病和其他呼吸系统疾病的人群，谨防慢阻肺的发生。

For more information: https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2024.226

Rate and Change in Household Solid Fuels Usage Among Residents Aged 40 and Older — China, from 2014–2015 to 2019–2020

Wenjing Wang¹; Shu Cong¹; Jing Fan¹; Ning Wang¹; Qian Wang²; Liwen Fang^1#

1 National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.

2 National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, Beijing, China.

^# Corresponding author: Liwen Fang, fangliwen@ncncd.chinacdc.cn.

Solid fuel combustion is a significant source of Household air pollution and an important risk factor for Chronic Obstructive Pulmonary Disease (COPD). Based on the data from  Chinese Chronic Obstructive Pulmonary Disease Surveillance, this study estimated the rates and change of solid fuels usage for cooking and heating from 2014–2015 to 2019–2020,  the rate of primary cooking solid fuels usage in 2019–2020, and analyzed the association between solid fuels usage and COPD. The rate of solid fuels uses for cooking and heating significantly decreased, dropping from 45.3% to 28.0% and from 33.5% to 23.2% respectively. During 2019–2020, 15.8% of residents predominantly used solid fuels for cooking. Usage was higher among rural residents, with 47.2% using it for cooking and 37.7% for heating. While there was a significant reduction in the use of solid fuels for cooking across all regions, the decrease in heating with solid fuels was particularly marked in North China. The usage of solid fuels for cooking is associated with increased risk of COPD. Among rural residents, combined usage of biomass and coal for cooking (OR=1.29, 95% CI: 1.12, 1.48) and using coal as primary fuel for cooking (OR=1.18, 95% CI: 1.00, 1.38) are associated with higher risk of COPD. The usage of biomass for cooking is associated with an increased risk of COPD in urban residents (OR=1.17, 95% CI: 1.03, 1.32).  It is of great public health importance to propose targeted fuel substitution measures for various solid fuels in different regions to reduce the risk of COPD.

40岁及以上居民家庭固体燃料使用率及其变化 — 中国，2014–2015 和 2019–2020年

王文静¹；丛舒¹；樊静¹；王宁¹；王前²；方利文^1#

1中国疾病预防控制中心慢性非传染性疾病预防控制中心，北京，中国；

2中国疾病预防控制中心妇幼保健中心，北京，中国；

^# 通信作者：方利文，fangliwen@ncncd.chinacdc.cn。

固体燃料燃烧造成的室内空气污染是慢阻肺患病的重要危险因素，但固体燃料使用状况及其变化的数据较为缺乏。本研究基于中国慢性阻塞性肺疾病监测数据，估计了从2014—2015到2019—2020年我国做饭和取暖固体燃料的使用率和变化，以及2019—2020年我国主要做饭固体燃料的使用率，并分析了固体燃料使用对慢阻肺的影响。本研究表明，居民做饭和取暖固体燃料使用率显著下降，分别从45.3%和33.5%降至28.0%和23.2%。2019–2020年，15.8%的居民主要使用固体燃料做饭。农村居民的做饭和取暖固体燃料使用率较高，分别为47.2%和37.7%。所有地区用于做饭的固体燃料的使用率均显著降低，华北地区取暖固体燃料使用的降低尤其明显。使用固体燃料做饭与居民COPD患病风险增加有关,使用生物燃料和煤燃料做饭（OR=1.29，95% CI：1.12，1.48）、主要使用煤燃料做饭（OR=1.18，95% CI：1.00，1.38）均与农村居民慢阻肺患病风险增加有关；使用生物燃料做饭与城镇居民COPD风险增加有关（OR=1.17，95% CI：1.03，1.32）。因此，针对不同地区不同类型固体燃料提出相应的替代措施以降低慢阻肺患病风险，具有重要的公共卫生学意义。For more information: https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2024.227.

The Association Between Preserved Ratio Impaired Spirometry and Mortality –– 10 CKB Study Areas, China, 2004–2022

Yalei Ke¹; Xinyi Zhang¹; Dianjianyi Sun^1,2,3; Pei Pei²; Huaidong Du⁴; Yiping Chen⁴; Ling Yang⁴; Xiaoming Yang⁴; Kang Wang⁵; Junshi Chen⁶; Zhengming Chen⁴; Jun Lyu^1,2,3,7; Liming Li^1,2,3; Canqing Yu^1,2,3#

1.Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China;

2.Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing, China;

3.Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, China;

4.Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK;

5.Shibei Center for Disease Control and Prevention, Qingdao City, Shandong Province, China;

6.China National Center for Food Safety Risk Assessment, Beijing, China;

7.State Key Laboratory of Vascular Homeostasis and Remodeling, Peking University, Beijing, China;

^# Corresponding author: Canqing Yu, yucanqing@pku.edu.cn.

China faces a significant burden from respiratory diseases, with a rising prevalence of chronic obstructive pulmonary disease (COPD). Preserved ratio impaired spirometry (PRISm) is a non-obstructive spirometry phenotype described as a transient state and associated with the progression of COPD. However, the mortality risk associated with PRISm remains uncertain, and the mortality risk of PRISm individuals in China is still unknown. This study, based on the China Kadoorie Biobank (CKB), analyzed the all-cause and cause-specific mortality risks in the PRISm population. The results show that compared to those with normal lung function, individuals with PRISm have a 37% higher risk of all-cause mortality (HR=1.37, 95% CI: 1.35, 1.40), with significantly increased risks of death from cardiovascular diseases, neoplasms, respiratory diseases, and infectious and parasitic diseases, comparable to those with obstructive spirometry pattern. Additionally, the mortality risk is higher in PRISm individuals with respiratory symptoms or diseases. This study is the first to comprehensively assess the mortality risk of PRISm in the Chinese population, highlighting the need to enhance attention to PRISm: raise public awareness, improve identification and management of high-risk individuals, and prevent its progression to COPD.

保留比值受损肺功能与死亡的关联 — 中国慢性病前瞻性研究10个项目地区，2004–2022年

柯雅蕾¹；张欣怡¹；孙点剑一^1,2,3；裴培²；杜怀东⁴；陈怡平⁴；杨玲⁴；杨小明⁴；王康⁵；陈君石⁶；陈铮明⁴；吕筠^1,2,3,7；李立明^1,2,3；余灿清^1,2,3#

1. 北京大学公共卫生学院流行病与卫生统计学系，北京，中国；

2. 北京大学公众健康与重大疫情防控战略研究中心，北京，中国；

3. 重大疾病流行病学教育部重点实验室（北京大学），北京，中国；

4. 牛津大学临床与流行病学研究中心纳菲尔德人群健康系，牛津，英国

5. 市北区疾病预防控制中心，青岛市，山东省，中国

6. 国家食品安全风险评估中心，北京，中国

7. 血管稳态与重构全国重点实验室，北京，中国

^# 通信作者：余灿清, yucanqing@pku.edu.cn。

中国的呼吸系统疾病负担较大，慢性阻塞性肺病（COPD）的患病率呈升高趋势。保留比值受损肺功能（PRISm）是一种非阻塞性肺功能异常，被认为可能是COPD前期人群之一。然而，目前对于PRISm相关死亡风险的了解仍然有限，尚不知道我国PRISm人群的死亡风险。本研究基于中国慢性病前瞻性研究（CKB）分析PRISm人群的全因及死因别死亡风险。结果显示，与肺功能正常者相比，PRISm人群的全因死亡风险升高37%（HR=1.37, 95% CI: 1.35, 1.40），并且心血管疾病、肿瘤、呼吸系统疾病及传染病的死亡风险也显著增加，这些风险水平与阻塞性肺功能者相当。此外，伴有呼吸系统症状或疾病的PRISm人群的死亡风险更高。本研究首次在中国人群中全面评估了PRISm的死亡风险，提示需加强对PRISm的关注，提高公众认知，加强对高危个体的识别与管理，预防其向COPD进展。

For more information: https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2024.228.

Prevalence and Risk Factors of Chronic Obstructive Pulmonary Disease Among Adults Aged 50 Years and Above — 10 CKB Study Areas, China, 2020–2021

Wei Yu¹; Yongbing Lan¹; Dianjianyi Sun^1,2,3; Pei Pei²; Ling Yang⁴; Yiping Chen⁴; Huaidong Du⁴; Yingcai Yang⁵; Dan Schmidt⁴; Junshi Chen⁶; Zhengming Chen⁴; Jun Lyu^1,2,3,7; Liming Li^1,2,3; Canqing Yu^1,2,3,#

1. Department of Epidemiology & Biostatistics, School of Public Health, Peking University, Beijing, China;

2. Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing, China;

3. Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, China;

4. Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom;

5. Shinan District Center for Disease Control and Prevention, Qingdao City, Shandong, Province, China;

6. China National Center for Food Safety Risk Assessment, Beijing, China;

7. State Key Laboratory of Vascular Homeostasis and Remodeling, Peking University, Beijing, China.

# Corresponding author: Canqing Yu, yucanqing@pku.edu.cn.

The chronic obstructive pulmonary disease (COPD) prevalence in Chinese aged 50 years and above was higher than that in younger adults, which risk factors were unclear. Besides, sex heterogeneity is a widely validated feature of COPD. Based on the third resurvey of the China Kadoorie Biobank conducted during 2020–2021, the present study included 6,707 males and 11,852 females aged 50 years and above to explore the sex-specific risk factors of COPD. The results revealed that 12.8% of males and 5.7% of females aged 50 years and above suffered from COPD. Among males and females aged 50 years and above, cigarette smoking, family history of respiratory diseases, respiratory symptoms, a history of respiratory diseases before 18 years old, and chronic cough until 14 years old were positively associated with COPD, whereas being overweight and obese was inversely associated with COPD. Quitting smoking and enhancing screening or treatment for individuals with a history of respiratory symptoms or diseases during childhood or adulthood might help prevent COPD for individuals aged 50 years and above.

50岁及以上成人慢阻肺患病率及危险因素 — 中国慢性病前瞻性研究10个项目地区，2020–2021年

喻唯¹；兰勇兵¹；孙点剑一^1,2,3；裴培²；杨玲⁴；陈怡平⁴；杜怀东⁴；杨英彩⁵；Dan Schmidt⁴；陈君石⁶；陈铮明⁴；吕筠^1,2,3,7, 李立明^1,2,3；余灿清^1,2,3,#

1. 北京大学公共卫生学院流行病与卫生统计学系，北京，中国；

2. 北京大学公众健康与重大疫情防控战略研究中心，北京，中国；

3. 重大疾病流行病学教育部重点实验室（北京大学），北京，中国；

4. 英国牛津大学临床与流行病学研究中心纳菲尔德人群健康系，牛津，英国；

5. 市南区疾病预防控制中心，青岛市，山东省，中国；

6. 国家食品安全风险评估中心，北京，中国；

7. 血管稳态与重构全国重点实验室，北京，中国。

^# 通信作者：余灿清，yucanqing@pku.edu.cn。

中国50岁及以上人群的慢阻肺患病（COPD）率明显高于50岁以下者，但其危险因素尚不清晰。此外，性别差异是慢阻肺已被广泛验证的特征。本研究以中国慢性病前瞻性研究项目在2020-2021年间开展的第三次重复调查为基础，分别纳入6,707名和11,852名50岁及以上的男性和女性研究对象，探索慢阻肺性别特异性危险因素。结果显示，50岁及以上男性和女性的慢阻肺患病率分别为12.8%和5.7%。在50岁及以上的男性和女性中，吸烟、呼吸系统疾病家族史、呼吸系统症状、18岁之前曾患有呼吸系统疾病、以及14岁之前曾患有慢性咳嗽与慢阻肺风险呈正相关；而超重和肥胖与慢阻肺风险呈负相关。为了预防50岁及以上人群的慢阻肺患病风险，应当倡导戒烟，并加强对儿童期或成年期有呼吸道症状或疾病史的人群进行筛查或治疗。

For more information: https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2024.229