Noncommunicable Respiratory Disease and Air Pollution Exposure in Malawi (CAPS). A Cross-Sectional Study.
Noncommunicable Respiratory Disease and Air Pollution Exposure in Malawi (CAPS). A Cross-Sectional Study.
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马拉维（CAPS）的非通信呼吸道疾病和空气污染暴露。一项横断面研究。
DOI：
10.1164/rccm.201805-0936oc
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发表时间：
2019-03-01
影响因子：
24.7
通讯作者：
Mortimer K
中科院分区：
文献类型：
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作者：
Nightingale R;Lesosky M;Flitz G;Rylance SJ;Meghji J;Burney P;Balmes J;Mortimer K
理由：非传染性呼吸系统疾病和接触空气污染被认为是撒哈拉以南非洲成年人发病和死亡的重要原因。目的：我们着手探讨生活在马拉维奇赫瓦瓦区的成年人中非传染性呼吸道疾病的患病率和决定因素。方法：我们在马拉维农村参加清洁燃烧生物质燃料炉灶干预（CAPS[烹饪和肺炎研究]）的随机对照试验的社区成年人中进行了一项横断面研究。我们评估了慢性呼吸道症状、肺活量异常和个人暴露于空气污染（空气动力学直径<2.5 μm的颗粒物[PM2.5]和一氧化碳[CO]）。计算加权患病率估计；进行了多变量和意向治疗分析。测量方法和主要结果：共招募了1481名参与者（平均[SD]年龄43.8[17.8]岁，57%为女性）。慢性呼吸道症状、肺活量测量障碍和限制的患病率分别为13.6%（95%可信区间[CI]， 11.9-15.4）、8.7% （95% CI, 7.0-10.7）和34.8% （95% CI, 31.7-38.0）。48小时个人PM2.5和CO暴露中位数分别为71.0 μg/m3（四分位数范围[IQR]， 44.6-119.2）和1.23 ppm （IQR, 0.79-1.93）。慢性呼吸道症状与吸烟/戒烟相关（优势比[OR]， 1.59; 95% CI, 1.05-2.39）、既往结核病（优势比，2.50;95% CI, 1.04-15.58）和一氧化碳暴露（优势比，1.46;95% CI, 1.04-2.05）。PM2.5暴露与任何人口统计学、临床或肺活量学特征无关。CAPS干预对任何次要试验结果没有影响。结论：马拉维农村成人慢性呼吸道症状、肺活量异常和空气污染暴露的负担具有相当大的潜在公共卫生重要性。我们发现很少有证据表明空气污染暴露与慢性呼吸道症状或肺活量异常有关，也没有证据表明CAPS干预对次要试验结果有影响。撒哈拉以南非洲需要更有效的非传染性呼吸道疾病预防和控制战略。临床试验在www.isrctn.com注册（ISRCTN 59448623）。
Rationale: Noncommunicable respiratory diseases and exposure to air pollution are thought to be important contributors to morbidity and mortality in sub-Saharan African adults. Objectives: We set out to explore the prevalence and determinants of noncommunicable respiratory disease among adults living in Chikhwawa District, Malawi. Methods: We performed a cross-sectional study among adults in communities participating in a randomized controlled trial of a cleaner-burning biomass-fueled cookstove intervention (CAPS [Cooking and Pneumonia Study]) in rural Malawi. We assessed chronic respiratory symptoms, spirometric abnormalities, and personal exposure to air pollution (particulate matter <2.5 μm in aerodynamic diameter [PM2.5] and carbon monoxide [CO]). Weighted prevalence estimates were calculated; multivariable and intention-to-treat analyses were done. Measurements and Main Results: One thousand four hundred eighty-one participants (mean [SD] age, 43.8 [17.8] yr; 57% female) were recruited. The prevalence of chronic respiratory symptoms, spirometric obstruction, and restriction were 13.6% (95% confidence interval [CI], 11.9–15.4), 8.7% (95% CI, 7.0–10.7), and 34.8% (95% CI, 31.7–38.0), respectively. Median 48-hour personal PM2.5 and CO exposures were 71.0 μg/m3 (interquartile range [IQR], 44.6–119.2) and 1.23 ppm (IQR, 0.79–1.93), respectively. Chronic respiratory symptoms were associated with current/ex-smoking (odds ratio [OR], 1.59; 95% CI, 1.05–2.39), previous tuberculosis (OR, 2.50; 95% CI, 1.04–15.58), and CO exposure (OR, 1.46; 95% CI, 1.04–2.05). Exposure to PM2.5 was not associated with any demographic, clinical, or spirometric characteristics. There was no effect of the CAPS intervention on any of the secondary trial outcomes. Conclusions: The burden of chronic respiratory symptoms, abnormal spirometry, and air pollution exposures in adults in rural Malawi is of considerable potential public health importance. We found little evidence that air pollution exposures were associated with chronic respiratory symptoms or spirometric abnormalities and no evidence that the CAPS intervention had effects on the secondary trial outcomes. More effective prevention and control strategies for noncommunicable respiratory disease in sub-Saharan Africa are needed. Clinical trial registered with www.isrctn.com (ISRCTN 59448623).