Analysis Of Pulmonary Ventilation Function And Its Influencing Factors Among Female Aged 40 Years Or Older In China

BackgroundLung function is an objective indicator of respiratory health.The worse the individual’s lung function is,the higher the risk of respiratory disease,cardiovascular disease,cancer and death is.FEV1,FVC and FEV1/FVC are the three most common indicators of pulmonary ventilation function.These can be used to judge the health status of pulmonary ventilation function,as well as the degree and type of pulmonary ventilation dysfunction.The exposure of tobacco smoke,biofuels,occupational dust and/or harmful gas and other risk factors will affect the health status of pulmonary ventilation function.At present,the majority of females are responsible for both social and family responsibilities in China,Females are relatively weak in health literacy level,social status and medical resources possession,and relatively high in exposure level of environmental risk factors such as second-hand smoke,biofuels and other indoor pollution fuels,occupational dust and/or harmful gases.The structure and physiological factors of lung dissection in female are different from those in male,which makes female more sensitive to smoke exposure.The above factors make female’s lung health and pulmonary ventilation function more vulnerable.TheREFore,it’s necessary to understand the status of pulmonary ventilation function,and analyze the prevalence and influencing factors of pulmonary ventilation dysfunction among female aged 40 years or older in China.It’s of great significance to evaluate the differences of lung ventilation function and health status with different characteristics in China among female.And it’s of great significance to implement targeted interventions to protect female’s lung health and reduce the incidence of pulmonary ventilation dysfunction.However,there is a lack of a national representative research on the status of women’s pulmonary ventilation function and its influencing factors recently.Based on the surveillance data of chronic obstructive pulmonary disease(COPD)of residents from 2014 to 2015 in China,this study analyzed the status of pulmonary ventilation function and its influencing factors among female aged 40 years or older.It can provide basic data for the research of female’s lung health and formulate the relevant prevention and protection strategies and measures.Objective1.To analyze the basic status of FEV1,FVC,FEV1/FVC of pulmonary ventilation function among female aged 40 years or older in China,and explore the related factors of FEV1 and FVC.2.To understand the basic status of FEV1,FVC,FEV1/FVC in pulmonary ventilation dysfunction among female aged 40 years or older.3.To reveal the prevalence of restrictive ventilation dysfunction,obstructive ventilation dysfunction and mixed ventilation dysfunction in China among female aged 40 years or older,and explore its related factors.Methods1.The data was from the survey of COPD surveillance in China from 2014 to 2015.The method of multi-stage stratified cluster sampling was used to conduct this survey in 125 surveillance sites(county/district)in 31 provinces(autonomous regions and municipalities)among residents aged 40 years or older.Using electronic questionnaire,the investigators who had been trained uniformly completed the questionnaire by face-to-face inquiry.At the same time,all subjects measured height,weight,waist circumference and did spirometry examination.The contents of the questionnaire mainly included the basic information,personal disease history,exposure of risk factors and contraindications of spirometry examination.In this study,all 37795 female population in this survey were selected for analysis.After excluding the samples without pulmonary function test data and unqualified pulmonary ventilation function before and after bronchodilation,,a total of 33042 subjects were finally included in this study.2.The mean and standard deviation(X±SD)were used to describe the main indicators of FEV1,FVC,FEV1/FVC of lung ventilation function.The linear regression based on complex sampling design was used to compare the differences of FEV1,FVC,FEV1/FVC between different characteristics among female.The multiple linear regression model based on complex sampling design was used to analyze the influencing factors of FEV1 and FVC in female population aged 40 years and over.Taylor series variance method was used to estimate 95%CI of sampling error and the rate of restrictive ventilation dysfunction,obstructive ventilation dysfunction and mixed ventilation dysfunction.Rao-Scott χ2 test based on complex sampling design was used to compare the prevalence of restrictive ventilation dysfunction,obstructive ventilation dysfunction and mixed ventilation dysfunction among female with different characteristics.The multiple Logistic regression model based on the complex sampling design was used to analyze the related factors of restrictive ventilation dysfunctions,obstructive ventilation dysfunctions and mixed ventilation dysfunctionsamong female aged 40 years or older.Results一、Analysis of the basic status and related factors of pulmonary ventilationfunction in China among female aged 40 years or older(一)The basic status of FEV1,FVC and FEV1/FVC of pulmonary ventilationfunction in China among female FEV1,FVC and FEV1/FVC of basic pulmonary ventilation function were(2.26±0.02)L/s,(2.89±0.03)L and(78.07±0.27)%,respectively.After bronchodilation,FEV1,FVC and FEV1/FVC were(2.31±0.02)L/S,(2.89±0.03)L and(79.92±0.20)%,respectively.With the increase of age,the FEV1,FVC and FEV1/FVC decreased(P<0.001).FEV1,FVC and FEV1/FVC of Han were(2.25±0.02)L/S,(2.89±0.03)L,(78.04±0.27)%,respectively.FEV1,FVC and FEV1/FVC of other ethnic were(2.29±0.04)L/S,(2.91±0.05)L,(78.77±0.56)%,respectively.There was no statistically significant in basic pulmonary ventilation function between the Han and the other ethnic(P>0.05).The current smokers FEV1,FVC and FEV1/FVC were(2.20±0.04)L/S,(2.94±0.06)L and(75.02±0.55)%,respectively.The former smokers FEV1,FVC and FEV1/FVC were(2.08±0.05)L/S,(2.77±0.06)L,(74.74±0.67)%,respectively.The non-smokers FEV1,FVC and FEV1/FVC were(2.26±0.02)L/S,(2.89±0.03)L,(78.25±0.26)%,respectively.There was statistically significant difference in basic pulmonary ventilation function among the current smoker,former smoker and the non-smoker(P<0.05).FEV1 and FVC with biofuel exposure were(2.19±0.03)L/S,(2.82±0.04)L,respectively.FEV1 and FVC without biofuel exposure were(2.26±0.02)L/S,(2.89±0.03)L,respectively.There was statistically significant difference in basic pulmonary ventilation function between the biofuel exposure and the non-biofuel exposure(P<0.05).FEV1,FVC and FEV1/FVC of patients with a history of tuberculosis were(2.04±0.04)L/S,(2.68±0.05)L and(75.75±0.61)%,which were both lower than those without a history of tuberculosis(P<0.001).FEV1 and FVC in central obesity were(2.23±0.02)L/S and(2.87±0.03)L.FEV1 and FVC in non-center obesity were(2.27±0.02)L/S and(2.91±0.03)L.There was statistically significant difference in basic pulmonary ventilation function between the central obesity and the non-center obesity(P<0.05).(二)The basic status of FEV1,FVC and FEV1/FVC of pulmonary ventilation function among female in different regions in ChinaThe basic lung ventilation function FEV1 and FVC among female aged 40 years or older in the North were(2.37±0.02)L/S and(3.04±0.03)L,respectively.The basic lung ventilation function FEV1 and FVC among female aged 40 years or older in the South were(2.15±0.02)L/S and(2.75±0.03)L,respectively.There was statistically significant difference in basic pulmonary ventilation function between the North and the South(P<0.001).FEV1,FVC and FEV1/FVC among urban female aged 40 years or older in China was(2.28±0.02)L/S,(2.92±0.03)L and(78.19±0.26)%,respectively.FEV1,FVC and FEV1/FVC among rural female aged 40 years or older in China was(2.23±0.02)L/S,(2.87±0.03)L and(77.97±0.36)%,respectively.There was no statistically significant difference in basic pulmonary ventilation function between urban female and rural female(P>0.05).(三)Related factors of FEV1 and FVC among female aged 40 years or olderFEV1 and FVC were used as the corresponding variables.Height,age,ethnic,marital status,education level,occupation,north and south,smoking status,occupational dust and/or harmful gas exposure,biofuel exposure,childhood respiratory infection,diabetes,BMI,central obesity and other factors were used as independent variables to establish multiple linear regression model.The result showed that height,age,north and south,diabetes history,BMI and central obesity were influencing factors for FEV1 and FVC.In addition,previous smoking and childhood respiratory infections were also influencing factors for FEV1.FEV1 and FVC increased with height(P<0.001).FEV1 and FVC decreased with age(P<0.001).FEV1 of former smokers was lower than that of never smokers(P<0.05).FEV1 in those with childhood respiratory infection was lower than those without childhood respiratory infection(P<0.001).FEV1 and FVC in those with history of diabetes were lower than those without history of diabetes(P<0.05).Those with low body weight have lower FEV1 and FVC than those with normal weight(P<0.05).FEV1 and FVC in those with central obesity were lower than those without central obesity(P<0.001).(四)Related factors of FEV1 and FVC of pulmonary ventilation function among females aged 40 years or older in North and South ChinaFEV1 and FVC of pulmonary ventilation function among female aged 40 years or older in northern China were higher than those in southern China.This study further explored the related factors of FEV1 and FVC of pulmonary ventilation function in the North and South regions,respectively.The results of the study showed that FEV1 was affected by age,height,childhood respiratory infection,low body weight and central obesity in the north and south.FVC was mainly affected by height,age,diabetes,low body weight and central obesity.In addition,FEV1 of pulmonary ventilation function was also affected by smoking and diabetes.(五)The effect of second-hand smoke exposure on FEV1 and FVC of pulmonary ventilation functionIn this study,the relationship between secondhand smoke exposure and the FEV1 and FVC of pulmonary ventilation function was further explored.After adjusting for height,age,marital status,ethnic,education level,north and south,biofuel exposure,occupational dust and/or harmful gas exposure,childhood respiratory infection,diabetes,BMI and central obesity,the results showed that second-hand smoke exposure was negatively correlated with FEV1 and FVC(P<0.05).二、The status of pulmonary ventilation function in China among female aged 40 years or older(一)Basic status of FEV1,FVC and FEV1/FVC in patients with restrictive ventilation dysfunctionsFEV1,FVC and FEV1/FVC of basic pulmonary ventilatory function of the patients with restrictive ventilatory dysfunction was(1.75±0.02)L/s,(2.15±0.02)L and(81.19±0.31)%,respectively.With the increase of age,FEV1,FVC and FEV1/FVC decreased(P<0.001).FEV1,FVC and FEV1/FVC of former smokers were(1.45±0.08)L/s,(1.87±0.10)L and(76.96±0.98)%,respectively.There was significant difference between groups with different smoking status(P<0.05).FEV1 and FVC of patients with diabetes were lower than those without diabetes(P<0.05).(二)Basic status of FEV1,FVC and FEV1/FVC in patients with obstructive ventilation dysfunctionsFEV1,FVC and FEV1/FVC of basic pulmonary ventilatory function of the patients with obstructive ventilatory dysfunction in China among female aged 40 years or older were(1.79±0.04)L/s,(2.85±0.05)L and(62.63±0.38)%respectively.With the increase of age,FEV1,FVC and FEV1/FVC decreased(P<0.001).FEV1 and FVC in patients with biofuel exposure were(1.73±0.04)L/s and(2.76±0.05)L,which were lower than those without biofuel exposure(P<0.05).FEV1,FVC and FEV1/FVC in low body weight patients were(1.50±0.06)L/s,(2.52±0.08)L and(59.51±1.60)%.(三)Basic status of FEV1,FVC and FEV1/FVC in patients with mixed ventilation dysfunctionsFEV1,FVC and FEV1/FVC of basic pulmonary ventilation function of the patients with mixed ventilatory dysfunction were(1.02±0.03)L/s,(1.74±0.03)L and(58.33±0.76)%respectively.With the increase of age,FEV1,FVC and FEV1/FVC decreased(P<0.05).With the increase of education level,FEV1 and FVC increased(P<0.001).FEV1 and FEV1/FVC of patients with asthma history were lower than those without asthma history(P<0.05).三.Analysis of the prevalence of restrictive ventilation dysfunction,obstructive ventilation dysfunction and mixed ventilation dysfunction in China among female aged 40 years or older,and its related factors(一)Restrictive ventilation dysfunction1.Prevalence of restrictive ventilation dysfunctionsIn China,the prevalence of restrictive ventilatory dysfunction among female aged 40 years or older was 7.80%(95%CI:6.45%-9.16%),8.23%(95%CI:6.55%～9.92%)in urban,7.40%(95%CI:5.85%～8.95%)in rural.There was statistical difference in the prevalence of restrictive ventilatory dysfunction between different age groups(P<0.05).The prevalence of restrictive ventilation dysfunction in patients with diabetes(10.02%,95%CI:7.34%～12.70%)was significantly higher than that in patients without diabetes(7.68%,95%CI:6.34%～9.02%)(P<0.05).The prevalence of restrictive ventilation dysfunction in central obesity(8.57%,95%CI:7.02%,10.13%)was higher than that in non-center obesity(7.16%,95%CI:5.73%～8.59%)(P<0.05).2.Influencing factors of restrictive ventilation dysfunctionsThe main risk factors of restrictive ventilatory dysfunction were explored by using the multi-factor Logistic regression model based on the complex sampling design.The factors such as age,marital status,education level,occupation,urban and rural areas,risk factor exposure,disease history,BMI and central obesity were included in the multi-factor Logistic regression model.The results showed that tuberculosis history and central obesity were the main risk factors of restrictive ventilation dysfunction.The risk of restricted ventilation dysfunction in patients with tuberculosis history was 2.07 times(OR=2.07,95%CI:1.48～2.89)than those without tuberculosis history.The risk of restricted ventilation dysfunction in patients with central obesity was 1.24 times(OR=1.24,95%CI:1.00～1.53)than those without central obesity.(二)Obstructive ventilation dysfunction1.Prevalence of obstructive ventilation dysfunctionsIn China,the prevalence of obstructive ventilatory dysfunction among female aged 40 years or older was 6.96%(95%CI:5.70%～8.21%),6.55%(95%CI:5.40%～7.69%)in urban and 7.34%(95%CI:5.71%～8.96%)in rural The prevalence of mild and moderate to severe obstructive ventilation dysfunctions in China among female aged 40 years or older was 4.30%(95%CI:3.33%～5.26%)and 2.66%(95%CI:2.20%～3.12%).With the increase of age,the prevalence of obstructive ventilation dysfunctions in female population increased(P<0.001).The prevalence of obstructive ventilation dysfunctions in education level of primary school or below was 8.46%(95%CI:6.98%～9.94%).The difference between groups with different education levels was statistically significant(P<0.001).The prevalence of obstructive ventilation dysfunction in former smokers was 14.39%(95%CI:9.98%～18.80%),14.21%(95%CI:11.05%～17.36%)among current smokers,and 6.49%(95%CI:5.23%-7.75%)among non-smokers.There was statistically significant difference in the prevalence of obstructive ventilation dysfunction among the current smoker,former smoker and the non-smoker(P<0.001).The prevalence of mild obstructive ventilation dysfunction in current smokers was 8.48%(95%CI:6.24%～10.71%).The prevalence of moderate to severe obstructive ventilation dysfunctions in former smokers was 7.30%(95%CI:4.14%～10.46%).There was significant difference in the prevalence of mild and moderate severe obstructive ventilatory dysfunction among the smokers with different smoking status(P<0.001).The prevalence of obstructive ventilatory dysfunction in patients with diabetes(9.26%,95%CI:6.58%～11.94%)was higher than that of patients without diabetes history(6.84%,95%CI:5.60%～8.08%)(P<0.05).2.Influencing factors of obstructive ventilation dysfunctionsThe result of Logistic regression model based on complex sampling design showed that the risk of obstructive ventilation was higher with the increase of age.The risk of obstructive ventilation in smokers was 2.14 times(OR=2.14,95%CI:1.60～2.86)higher than that in non-smokers.Patients with occupational dust and/or harmful gas exposure were 1.25 times(OR=1.25,95%CI:1.01～1.55)more likely to have obstructive ventilation dysfunction than those without occupational dust and/or harmful gas exposure.Those with childhood respiratory infection were 2.20 times(OR=2.20,95%CI:1.48～3.27)more likely to have obstructive ventilation dysfunction than those without childhood respiratory infection.Those with history of asthma were 3.58 times(OR=3.58,95%CI:2.74～4.66)more likely to have obstructive ventilation dysfunction than those without asthma.(三)Mixed ventilation dysfunction1.Prevalence of mixed ventilation dysfunctionsThe prevalence of mixed ventilatory dysfunction among female aged 40 years or older was 1.11%(95%CI:0.93%～1.30%),1.00%(95%CI:0.76～1.25)in urban and 1.21%(95%CI:0.93%～1.50%)in rural.With the increase of age,the prevalence of mixed ventilation dysfunctions in female increased(P<0.001).The prevalence of mixed ventilation dysfunctions in primary school or below was 1.54%(95%CI:1.24%～1.84%).The difference between groups with different education levels was statistically significant(P<0.001).The prevalence of mixed ventilation dysfunctions in former smokers was 3.18%(95%CI:0.96%～5.39%).There was significant difference between groups with different smoking status(P<0.05).The prevalence of mixed ventilation dysfunction in central obesity(1.33%,95%CI:1.04%～1.63%)was higher than that in non-center obesity(0.93%,95%CI:0.71%～1.16%)(P<0.05).2.Influencing factors of mixed ventilation dysfunctionThe result of Logistic regression model based on complex sampling design showed that age,occupation,childhood respiratory infection,history of tuberculosis,history of coronary heart disease,history of asthma,and BMI were the main risk factors for mixed ventilation dysfunctions.With increasing age,the risk of mixed ventilation dysfunctions increased.The risk of mixed ventilation dysfunctions in childhood respiratory infection was 3.00 times(OR=3.00,95%CI:1.48～6.08)higher than that in childhood respiratory infection.The risk of mixed ventilation dysfunctions in people with tuberculosis was 3.27 times(OR=3.27,95%CI:1.65～6.49)higher than that in people without tuberculosis.The risk of mixed ventilation dysfunction in patients with history of asthma was 5.04 times(OR=5.04,95%CI:2.76～9.20)higher than that in patients without history of asthma.The risk of mixed ventilation dysfunction in low body weight group was 2.76 times(OR=2.76,95%CI:1.54～4.95)higher than that in normal body weight group.Conclusions1.The basic pulmonary ventilation function FEV1,FVC,FEV1/FVC among female aged 40 years or older in China were(2.26±0.02)L/S,(2.89±0.03)L and(78.07±0.27)%,respectively.After bronchodilation,FEV1,FVC and FEV1/FVC were(2.31±0.02)L/S,(2.89±0.03)L and(79.92±0.20)%,respectively.There were regional differences in lung ventilation function,and the North was higher than the South.2.With the increase of age,FEV1 and FVC of the pulmonary ventilation function in China among female aged 40 years or older decreased.Female with second-hand smoke exposure,diabetes,low BMI,and central obesity had lower FEV1 and FVC.3.The prevalence of restrictive ventilation dysfunctions among female aged 40 years or older in China was 7.80%,which was higher than the prevalence of obstructive ventilation dysfunctions and mixed ventilation dysfunctions.It was mainly influenced by tuberculosis history and central obesity.4.The prevalence of obstructive ventilation dysfunction among female population≥40 years old in China was 6.96%.Age,current smoking,occupational dust and/or harmful gas exposure,childhood respiratory infections,and history of asthma were risk factors for obstructive ventilation dysfunctions.5.The prevalence of mixed ventilatory dysfunctions among female aged 40 years or older in China was 1.11%.Age,childhood respiratory infections,tuberculosis,asthma,and low BMI were influencing factors for mixed ventilation dysfunctions.