中国10个地区成年人心力衰竭流行情况及其吸烟影响因素研究  

Prevalence of heart failure and its association with smoking behavior in adults from 10 regions of China

作　　者：杨若彤 韩雨廷 吕筠[1] 余灿清[1] 郭彧[2] 卞铮[2] 裴培[2] 杜怀东[3] 陈君石 陈铮鸣[3] 黄涛 李立明[1] 中国慢性病前瞻性研究项目协作组 Yang Ruotong;Han Yuting;Lyu Jun;Yu Canqing;Guo Yu;Bian Zheng;Pei Pei;Du Huaidong;Chen Junshi;Chen Zhengming;Huang Tao;Li Liming;China Kadoorie Biobank Collaborative Group(Department of Epidemiology and Biostatistics,School of Public Health,Peking University/Peking University Center for Public Health and Epidemic Preparedness&Response/Peking University Key Laboratory of Molecular Cardiovascular Sciences,Ministry of Education,Peking University,Beijing 100191,China;Chinese Academy of Medical Sciences,Beijing 100730,China;Clinical Trial Service Unit and Epidemiological Studies Unit,Nuffield Department of Population Health/Medical Research Council Population Health Research Unit,University of Oxford,Oxford OX37LF,UK;China National Center for Food Safety Risk Assessment,Beijing 100022,China;不详)

机构地区：[1]北京大学公共卫生学院流行病与卫生统计学系/北京大学公众健康与重大疫情防控战略研究中心/北京大学分子心血管学教育部重点实验室,100191 [2]中国医学科学院,北京100730 [3]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/英国牛津大学医学研究委员会人口健康研究组,OX37LF [4]国家食品安全风险评估中心,北京100022 [5]不详

出　　处：《中华流行病学杂志》2021年第5期787-793,共7页Chinese Journal of Epidemiology

基　　金：国家自然科学基金(81941018);国家重点研发计划(2016YFC0900500,2016YFC0900501,2016YFC0900504,2016YFC1303904);中国香港KadoorieCharitable基金。

摘　　要：目的:描述我国心力衰竭(心衰)流行情况,探究吸烟行为与心衰发病风险的前瞻性关联。方法:研究对象来自中国慢性病前瞻性研究,基线调查为2004年6月至2008年7月。剔除BMI信息缺失、基线调查后即失访以及基线自报有冠心病、脑卒中或恶性肿瘤的研究对象,共纳入487197人进行分析。本研究使用的随访数据截至2016年12月31日。采用Cox比例风险模型计算吸烟行为与心衰发病风险的关联。结果:研究对象中位随访10.15年,随访期间共有4208人新发心衰,粗发病率为0.87/1000人年,累积发病率为0.86%。基线年龄越大,心衰发病率越高。高年龄组、农村、男性心衰发病率分别高于低年龄组、城市、女性人群。相比于非吸烟者,偶尔吸烟者心衰发病风险无显著差异(HR=1.05;95%CI:0.91~1.22),而既往吸烟者(HR=1.48;95%CI:1.31~1.67)和当前吸烟者(HR=1.34;95%CI:1.22~1.49)的风险升高。合并非吸烟或偶尔吸烟者组后,既往吸烟者(HR=1.33;95%CI:1.21~1.46)和当前吸烟者(HR=1.46;95%CI:1.31~1.64)相比于该组的心衰发病风险均升高。当前吸烟者(趋势检验P=0.347)和既往吸烟者(趋势检验P=0.066)的吸烟量与心衰风险间均不存在剂量反应关系。与非吸烟或偶尔吸烟组相比,既往吸烟者戒烟<5、5~、10~、≥20年的心衰发病风险比分别为1.61(95%CI:1.36~1.92)、1.55(95%CI:1.27~1.90)、1.24(95%CI:1.02~1.51)、1.35(95%CI:1.08~1.68)(趋势检验P=0.091),非因疾病戒烟者与因疾病戒烟者心衰发病风险比分别为1.23(95%CI:1.04~1.45)和1.62(95%CI:1.41~1.86)。健康吸烟行为较非健康吸烟行为对心力衰竭有明显的保护作用(HR=0.75;95%CI:0.69~0.81)。城乡地区和冠心病家族史与吸烟行为是否健康存在对心衰发病风险的交互作用(交互检验P<0.05)。结论:我国心力衰竭发病率男性高于女性,农村高于城市,随年龄增长而升高。无论吸烟频率、吸烟量、戒烟时长和戒烟原因,既往吸烟和当前�Objective To describe the prevalence of heart failure in China and to explore the prospective association between smoking behavior and the risk of incident heart failure.Methods The subjects were from the China Kadoorie Biobank(CKB)and the baseline survey was conducted from June 2004 to July 2008.A total of 487197 subjects were included in this study,after excluding those with missing BMI information,lost follow-up immediately after baseline investigation,and self-reported coronary heart disease,stroke,or malignant tumor at baseline.This study included data from baseline and follow-up until December 31,2016.Cox proportional hazards regression models were used to estimate the association between smoking behavior and the risk of heart failure.Results The median follow-up time was 10.15 years,during which a total of 4208 new cases of heart failure occurred,with a crude incidence rate of 0.87/1000 person-years and a cumulative incidence rate of 0.86%.The higher the age at baseline,the higher the incidence of heart failure.The incidence of heart failure in high age group,rural area and male was higher than that in low age group,urban area and female population respectively.Compared with non-smokers,there was no significant difference in the risk of heart failure in occasional smokers(HR=1.05;95%CI:0.91-1.22),while former smokers(HR=1.48;95%CI:1.31-1.67)and current smokers(HR=1.34;95%CI:1.22-1.49)increased risk.Former smokers(HR=1.33;95%CI:1.21-1.46)and current smokers(HR=1.46;95%CI:1.31-1.64)had higher risk of heart failure than non-smokers or occasional smokers.No dose-response relationship was observed between the number of cigarettes smoked per day and the risk of heart failure in current and former smokers(for trend P=0.347 and 0.066).Compared with non-smokers or occasional smokers,the hazard ratios of<5,5-,10-and≥20 years since quit smoking were 1.61(95%CI:1.36-1.92),1.55(95%CI:1.27-1.90),1.24(95%CI:1.02-1.51)and 1.35(95%CI:1.08-1.68),respectively(for trend P=0.091).The hazard ratios of quitting smoking due to

关 键 词：心力衰竭 吸烟行为 戒烟 

分 类 号：R541.6[医药卫生—心血管疾病] R181.3[医药卫生—内科学]