Reply to Wei: Are Rural Residence and Poverty Independent Risk Factors for Chronic Obstructive Pulmonary Disease in the United States?
Reply to Wei: Are Rural Residence and Poverty Independent Risk Factors for Chronic Obstructive Pulmonary Disease in the United States?
复制标题
回复魏：农村居民和贫困是美国慢性阻塞性肺病的独立危险因素吗？
DOI：
10.1164/rccm.201905-0974le
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发表时间：
2019
影响因子：
24.7
通讯作者：
McCormack,MeredithC
中科院分区：
文献类型：
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作者：
Raju,Sarath;Keet,CorinneA;McCormack,MeredithC
我们感谢魏博士的来信并对我们最近的出版物感兴趣(1)。魏博士提请注意我们研究使用的国民健康访谈调查数据中缺乏肺功能数据的问题。我们在论文中指出，缺乏肺功能数据，包括FEV1，是我们研究的局限性。国家健康访谈调查的大规模性质部分抵消了这一限制，该调查使我们能够独特地检查导致全美慢性阻塞性肺疾病(COPD)发展的社区和个人层面的因素。此外，我们还能够在该数据集中使用不同的COPD定义进行多项敏感性分析，表明农村居住地仍然与COPD独立相关。最终，尽管我们对我们的研究有信心，但我们确实同意应该努力在包括肺功能数据的全国代表性样本中验证这些结果。魏博士提出的第二点是关于体重指数和肥胖是否可能是混杂因素。虽然没有包括在最后的论文中，但我们的早期分析版本解释了肥胖，这最终没有改变农村居住地和COPD患病率之间的联系。目前正在努力更好地了解肥胖和饮食对美国农村地区COPD发病率的影响。最后，魏博士引用的文章描述了更好地了解可能有助于肺发育和早期肺功能损害的因素的重要性。虽然这超出了我们的横断面分析范围，但我们对未来研究农村贫困地区的因素非常感兴趣，包括营养和环境暴露，这些因素可能会影响肺部发育，并导致观察到的COPD患病率的城乡差异(2-4)。
We thank Dr. Wei for his letter and interest in our recent publication (1). Dr. Wei brings attention to the lack of lung function data in the National Health Interview Survey data used for our study. We noted in our paper that the lack of lung function data, including FEV1, was a limitation of our study. This limitation was partially countered by the large-scale nature of the National Health Interview Survey, which allowed us to uniquely examine the community and individual level factors that contribute to chronic obstructive pulmonary disease (COPD) development across the United States. We were additionally able to perform multiple sensitivity analyses within this data set, using differing definitions of COPD, demonstrating that rural residence remained independently associated with COPD. Ultimately, although confident in our study, we do agree that there should be efforts to validate these results in a nationally representative sample that includes lung function data. The second point Dr. Wei raises is in regard to whether body mass index and obesity may be confounders. Although not included in the final paper, an earlier version of our analysis accounted for obesity, which ultimately did not change the association between rural residence and COPD prevalence. Current efforts are underway to better understand the contribution of obesity and diet to COPD morbidity in rural regions of the United States. Last, the articles that Dr. Wei references describe the importance of better understanding factors that may contribute to lung development and early lung function impairment. Although this was beyond the scope of our cross-sectional analysis, we have great interest in future efforts to study factors in rural, poor regions, including nutrition and environmental exposures, which may influence lung development and contribute to the observed urban-rural disparities in COPD prevalence (2-4).■