总体人群中抽样14,669名受试者慢性咳嗽的危险因素
2017/10/09
背景：总体人群中慢性咳嗽的危险因素并未被系统地描述。我们应用来自哥本哈根总体人群研究中14,669名受试者的数据对在个体和社会层面慢性咳嗽危险的因素进行识别并排序。
方法：本研究采用LCQ问卷对慢性咳嗽的严重程度进行评估。我们按照对年龄矫正后的ORs值及人群归因风险（PARs），分别在个体及社会层面对慢性咳嗽危险因素进行排序。
结果：慢性咳嗽在总体人群中的发病率为4%，在不吸烟人群中的发病率为3%，在既往吸烟人群中的发病率为4%，在当前吸烟者中的发病率为8%。LCQ问卷中生理评分的中位数为5.8（第25-75百分位, 5.0-6.3），心理评分的中位数为5.6（第25-75百分位, 4.6-6.3），社会评分的中位数为6.3（第25-75百分位, 5.5-6.8），总评分为17.3（第25-75百分位, 15.4-18.9）。在个体层面，排在前三位的危险因素（对年龄矫正后的）ORs值分别为：不吸烟者中的支气管扩张5.0 (95% CI, 1.4-18)，哮喘2.6 (95% CI, 1.7-3.9)，以及胃食管反流疾病2.3 (95% CI, 1.5-3.4)；既往吸烟者中的支气管扩张7.1 (95% CI, 2.6-20)，哮喘3.1 (95% CI, 2.2-4.4)以及职业粉尘暴露2.2 (95% CI, 1.5-3.2)；当前吸烟者中的气流受限1.9 (95% CI, 1.3-2.9)。从社会层面来看，排在前三位的危险因素分别为：不吸烟者中的女性性别 (PAR, 19%), 哮喘 (PAR, 10%), 以及胃食管反流疾病 (PAR, 8%)；既往吸烟者的腹型肥胖 (PAR, 20%),低收入(PAR, 20%), 以及哮喘(PAR, 13%)；当前吸烟者的气流受限(PAR, 23%)。
结论：慢性咳嗽的危险因素在不同的个体、社会层面以及吸烟（与否）状态下各有不同，因此应该针对慢性咳嗽的危险因素来选择相应的个体化预防及治疗策略。
（Chest. 2017 ;152(3):563-573.）
Risk Factors for Chronic Cough Among 14,669 Individuals From the General Population.
Çolak Y, Nordestgaard BG, Laursen LC, Afzal S, Lange P, Dahl M.
Abstract
BACKGROUND:Risk factors for chronic cough in the general population have not been described systematically. We identified and ranked chronic cough risk factors at the individual and community level using data from 14,669 individuals from the Copenhagen General Population Study.
METHODS:Severity of chronic cough was assessed using the Leicester Cough Questionnaire (LCQ). We ranked chronic cough risk factors based on magnitude of age-adjusted ORs at the individual level and of the population attributable risks (PARs) at the community level.
RESULTS:Prevalence of chronic cough in the general population was 4% overall and 3% in never smokers, 4% in former smokers, and 8% in current smokers. Median score of the LCQ was 5.8 (25th-75th percentile, 5.0-6.3) for physical domain, 5.6 (25th-75th percentile, 4.6-6.3) for psychologic domain, 6.3 (25th-75th percentile, 5.5-6.8) for social domain, and 17.3 (25th- 75th percentile, 15.4-18.9) in total. At the level of the individual, age-adjusted ORs for the three top-ranked risk factors were 5.0 (95% CI, 1.4-18) for bronchiectasis, 2.6 (95% CI, 1.7-3.9) for asthma and 2.3 (95% CI, 1.5-3.4) for gastroesophageal reflux disease in never smokers, 7.1 (95% CI, 2.6-20) for bronchiectasis, 3.1 (95% CI, 2.2-4.4) for asthma and 2.2 (95% CI, 1.5-3.2) for occupational exposure to dust/fumes in former smokers, and 1.9 (95% CI, 1.3-2.9) for airflow limitation in current smokers. At the level of the community, the three top-ranked risk factors were female sex (PAR, 19%), asthma (PAR, 10%), and gastroesophageal reflux disease (PAR, 8%) in never smokers; abdominal obesity (PAR, 20%), low income (PAR, 20%), and asthma (PAR, 13%) in former smokers; and airflow limitation (PAR, 23%) in current smokers.
CONCLUSIONS:Risk factors for chronic cough differ at the level of the individual and community, and by smoking status. Strategies to prevent and treat modifiable chronic cough risk factors should be tailored accordingly.
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