Regional differences in the contribution of smoking, dietary and cooking behaviours to airflow obstruction in China: A population‐based case–control study. Issue 1 (23rd August 2022)

• Record Type: Journal Article
• Authors: Yan, Ruohua; Duong, MyLinh; Tse, Lap Ah; Yin, Lu; Rangarajan, Sumathy; Yusuf, Salim; Hou, Yan; Xu, Zhengting; Li, Jinyuan; Li, Wei
• Is Part Of: Respirology. Volume 28:Issue 1(2023)
• Page Start: 37
• Page End: 46
• Publication Date: 2022-08-23
• Subjects: airflow obstructive -- biomass -- chronic obstructive pulmonary disease -- diet -- risk factor -- smoke; Respiratory organs -- Diseases -- Periodicals; Respiratory organs -- Periodicals; 612.2
• DOI: 10.1111/resp.14347
• Languages: English
• ISSNs: 1323-7799

Abstract

Abstract: Background and objective: The major contributing risk factors to airflow obstruction (AO) in China remain largely unknown. We examined the environmental and lifestyle risk factors of unrecognized AO in the baseline of a population‐based cohort drawn from 115 urban and rural communities across 12 provinces in China. Methods: Amongst 46, 285 adults recruited from 2005 to 2009, 3686 were identified with AO on spirometry (defined by the ratio of forced expiratory volume in the first second to forced vital capacity <0.7) and without known chronic lung disease. These cases were age‐ and sex‐matched to 11, 129 controls with normal spirometry and no chronic lung disease from the same community. Conditional multivariable adjusted OR and population attributable fraction (PAF) were calculated for each identified risk factor and their combined effect. Results: Compared to controls, smoking initiation age <20 years (OR 1.22 [95% CI 1.01–1.48]), smoking duration ≥40 years (OR 1.82 [1.50–2.22]), low vegetables (OR 1.86 [1.67–2.07]) and fruits (OR 1.14 [1.02–1.29]) intake, cooking with biomass fuels (OR 2.54 [2.32–2.78]) and poor kitchen ventilation (OR 1.37 [1.19–1.58]) were significantly associated with elevated risks of unrecognized AO. The combined effect of these lifestyle factors significantly elevated the odds by 25 fold (18.6–34.3). The addition of prior tuberculosis and low socioeconomic status further increased the odds to 40.1 (28.2–57.0) and the PAF to 66.7% (51.1–78.1). Conclusion: Smoking, unhealthy diet, biomass cooking fuels and low socioeconomic status are strongly associated with AO. Addressing these risk factors could substantially reduce the burden of AO in China. Abstract : Poor kitchen ventilation, cooking with biomass fuels, low intake of fruits and vegetables, early age of smoking initiation and long duration of smoking, prior tuberculosis, low income and blue‐collar jobs are strongly associated with airflow obstruction and collectively contribute to two thirds of its population attributable risk in China.