RISK FACTORS FOR CHRONIC OBSTRUCTIVE PULMONARY DISEASE

慢性阻塞性肺疾病（COPD）是肺动脉高压的主要原因。 发病率和死亡率。 发达 COPD主要与吸烟有关。 寻找 定义对香烟烟雾的敏感性的因素是一个重要的 只有15%的吸烟者会患上COPD。 COPD也是导致 1973- 1975年中国农村地区的发病率和过早死亡率 在受影响最严重的地区，65岁以下的累积死亡率为16%。 70年代中期，中国的女性和男性死亡率大致相当 尽管在吸烟频率上存在巨大差异（77%的男性 女性为12%）。 这可能反映了低累积暴露于 可能表明其他风险的重要性 因素 20世纪80年代，中国的卷烟产量增加了， 戏剧性地，今天的年轻人将达到中年和老年 在下一个世纪会有高累积暴露水平。 拟议 该项目旨在确定与该人群中COPD风险相关的因素 吸烟的全部影响还不明显。 的 研究可获得详细信息，包括肺功能 测试和血压测量使用标准化的方法， 一组大约10，000名35-64岁的男性和女性，居住在 中国农村69个县，台湾16个县。 本研究 人口提供了许多优势，包括低累积包年 暴露和包括年龄在内的许多潜在风险因素的完整数据， 性、吸烟、饮酒、儿童期暴露、室内空气污染、 成人病史和通过问卷测量的营养状况 和生化标志物。 设想了三个相辅相成的次级项目， 这个项目的具体目标。 第一阶段，县级COPD 1986- 1988年的死亡率数据和发病率的汇总计量（汇总 个体肺量计读数）将用于生态分析， 检查与暴露的简要措施有关。 接下来，数据 个别研究对象将被用来检查的关系， 通过肺功能评估COPD发病率的各种因素 测试和呼吸道症状问卷。 最后，更小 个体研究计划采用嵌套病例对照或 队列设计，进一步探讨生化指标与 营养状况与COPD发病率的关系。

Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality throughout the developed world. In developed countries COPD is primarily related to cigarette smoking. The search for factors that define susceptibility to cigarette smoke is an important task as only 15% of smokers develop COPD. COPD also is a leading cause of morbidity and premature mortality in rural China and in 1973-5 cumulative mortality to age 65 was 16% in the worst affected areas. Female and male mortality rates in China were about equal in the mid-70s despite dramatic differences in the frequency of smoking (77% of men versus 12% of women). This may reflect the low cumulative exposure to manufactured cigarettes and may indicate the importance of other risk factors. In the 1980s the manufacture of cigarettes in China increased dramatically, and the young people of today will reach middle and old age in the next century with high cumulative exposure levels. The proposed project seeks to identify factors related to COPD risk in this population where the full effects of cigarette smoking are not yet evident. The study has access to detailed information, including pulmonary function tests and blood pressure measurements using standardized methodology, on a cohort of approximately 10,000 35-64 year old men and women residing in 69 counties in rural China and 16 counties in Taiwan. This study population offers many advantages including low cumulative pack-years exposure and complete data on many potential risk factors including age, sex, smoking, alcohol intake, childhood exposures, indoor air pollution, adult medical history, and nutritional status measured by questionnaire and biochemical markers. Three complementary subprojects are envisioned to meet the specific aims of this project. At the first stage, county-level COPD mortality data from 1986-88 and summary measures of morbidity (aggregated individual spirometry readings) will be used in ecologic analyses and examined in relation to summary measures of exposure. Next, data on individual study subjects will be used to examine the relation of a variety of factors to COPD morbidity, assessed through pulmonary function testing and a respiratory symptom questionnaire. Finally, smaller studies of individuals are planned using either nested case-control or cohort designs, to further explore the relation of biochemical markers of nutritional status to COPD morbidity.