COPD and its association with smoking in the Mainland China: a cross-sectional analysis of 0.5 million men and women from ten diverse areas

• Published in: International journal of chronic obstructive pulmonary disease Vol. 10; pp. 655 - 665
• Main Authors: Kurmi, Om P, Li, Liming, Wang, Jenny, Millwood, Iona Y, Chen, Junshi, Collins, Rory, Guo, Yu, Bian, Zheng, Li, Jiangtao, Chen, Biyun, Xie, Kaixu, Jia, Weifan, Gao, Yali, Peto, Richard, Chen, Zhengming
• Format: Journal Article
• Language: English
• Published: New Zealand Dove Medical Press Limited 01-01-2015; Dove Medical Press Ltd; Dove Medical Press
• Subjects: Adult; Age Factors; Age groups; Aged; Analysis; Asthma; Biobanks; Bronchitis; Carbon monoxide; China - epidemiology; Chronic illnesses; Chronic obstructive pulmonary disease; Confidence intervals; Cross-Sectional Studies; Education; Emphysema; Family income; Female; Forced Expiratory Volume; Health aspects; Health Surveys; Humans; Logistic Models; Lung - physiopathology; Lung diseases, Obstructive; Male; Middle Aged; Mortality; Odds Ratio; Original Research; Population; Prevalence; Prevalence studies (Epidemiology); Protective Factors; Pulmonary Disease, Chronic Obstructive - diagnosis; Pulmonary Disease, Chronic Obstructive - epidemiology; Pulmonary Disease, Chronic Obstructive - physiopathology; Risk Assessment; Risk Factors; Sex Factors; Smoking; Smoking - adverse effects; Smoking - epidemiology; Smoking - physiopathology; Smoking Cessation; Smoking Prevention; Time Factors; Tobacco; Vital Capacity; Womens health; China; United States > US; Mainland China; China Kadoorie Biobank; airflow obstruction; chronic respiratory diseases; smoking cessation
• ISSN: 1178-2005; 1176-9106; 1178-2005
• DOI: 10.2147/COPD.S75454

In adult Chinese men, smoking prevalence is high, but little is known about its association with chronic respiratory disease, which is still poorly diagnosed and managed.
A nationwide study recruited 0.5 million men and women aged 30-79 years during 2004-2008 from ten geographically diverse areas across the Mainland China. Information was collected from each participant regarding smoking and self-reported physician diagnosis of chronic bronchitis/emphysema (CB/E), along with measurement of lung function indices. Logistic regression was used to yield sex-specific odds ratios (ORs) relating smoking to airflow obstruction (AFO), defined as forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) <0.7 and CB/E, adjusting for age, areas, education, and income.
Overall 74% of men were ever regular smokers; among them, 7.2% had AFO compared with 5.4% in never-smokers, yielding an OR of 1.42 (95% confidence interval [CI]: 1.34-1.50). The risk was strongly associated with amount smoked and starting to smoke at a younger age. Among ex-smokers, the OR was more extreme for those who had quit due to illness (OR: 1.86, 95% CI: 1.77-1.96) than those who had quit by choice (OR:1.08, 95% CI: 1.01-1.16). CB/E prevalence was also significantly elevated in ex-smokers who had quit because of ill health (OR:2.79, 95% CI: 2.64-2.95), but not in regular smokers (OR:1.04, 95% CI: 0.96-1.11). Female smokers was rare (3%), but carried an excess risk for AFO (OR:1.53, 95% CI: 1.43-1.65) and, to a lesser extent, for CB/E (OR:1.28, 95% CI: 1.15-1.42).
In Mainland China, adult smokers, particularly ex-smokers who had quit because of illness, had significantly higher prevalence of chronic respiratory disease. AFO appeared to be more strongly associated with smoking than self-reported chronic respiratory disease.