| Objective With high morbidity and mortality,lung cancer has become a serious chronic disease threatening human life and health.The prevention and treatment of lung cancer has become a major challenge for the prevention and control of malignant tumors in China.In recent years,LDCT screening has gradually become the most commonly used and effective screening method for lung cancer.LDCT screening for lung cancer in high-risk population is not only beneficial to the prevention and control of lung cancer,but also in line with health economic benefits.In this study,a prospective cohort study was established based on the community population at high risk of lung cancer.Through follow-up,questionnaire survey,combined with LDCT screening,nodular outcome data and lifestyle change data were collected to analyze the lifestyle change and nodular outcome of the high-risk population,and to explore the influencing factors of lifestyle change and nodular outcome.To provide scientific basis for early diagnosis and treatment of lung cancer.MethodsFrom June to November 2020,10038 community residents aged 50 to 74 years old in Huashan District of Ma’anshan City were surveyed by health risk questionnaire and the high-risk population of lung cancer were evaluated.The lung cancer screening cohort of Ma’anshan City was established for baseline LDCT screening,and 2289 high-risk population participating in baseline screening were followed up.A centralized follow-up questionnaire survey was conducted from June to September 2021,and two centralized free LDCT follow-up screenings were conducted from June to September 2021 and from June to September 2022.During the follow-up,lifestyle and behavioral habits such as smoking,passive smoking,drinking,sleeping habits,physical exercise,LDCT screening results and lung cancer pathological diagnosis report were mainly collected.Based on the baseline data,the changes in lifestyle and behavioral habits of high-risk population during the follow-up period were analyzed.Combined with the results of univariate analysis,unconditional logistic regression was used to further analyze the related factors affecting the changes in lifestyle and behavioral habits.Then,based on the baseline data,the outcomes of nodules detected in the population during the follow-up period were analyzed,and combined with the results of univariate analysis,logistic regression was used to further explore the related factors affecting the outcome of nodules.ResultsA total of 2289 people at high risk of lung cancer were included at baseline,including1581 male residents(69.1%)and 708 female residents(30.9%).A total of 290 patients(12.7%)were found to have positive nodules,549 patients(24.0%)were found to have negative nodules,and 1450 patients(63.3%)were found to have no nodules through baseline screening.The detection rate of nodules was 36.7%.Univariate analysis showed that there were statistically significant differences among residents with different nodules detected in different ages,different genders,passive smoking,physical exercise,drinking status,and different sleep time(P < 0.05).After a year of questionnaire survey,a total of 1990 people were followed up,with a follow-up rate of 86.9%.The results of multivariate logistic regression analysitrs showed that compared with those whose annual household income <20000 yuan,residents with annual household income of 20000～ yuan were more likely to participate in the follow-up questionnaire(OR=1.68,95%CI: 1.01-2.80),and residents with annual household income of 50000～ yuan were also more likely to participate in the follow-up questionnaire(OR=2.09,95%CI: 1.23-3.54).Compared with non-smokers,smokers were more likely not to participate in the follow-up questionnaire(OR=0.61,95%CI:0.37-0.99).Compared with those who did not participate in physical exercise,those who participated in physical exercise were more likely to participate in the follow-up questionnaire(OR=1.63,95%CI: 1.26-2.12).Compared with those with no nodules detected at baseline,those with nodules detected at baseline were more likely to participate in the follow-up questionnaire(OR=1.54,95%CI: 1.17-2.02).Among 1990 high-risk follow-up groups,there were statistically significant differences between baseline and follow-up in smoking status,alcohol consumption status,physical exercise,sleep latency and sleep time(P < 0.05).Compared with baseline,smoking rates decreased and smoking cessation rates increased at follow-up.The number of people who drink is down and the number who abstain is up;The number of people taking physical exercise has increased;The number of people sleep latency <10 minutes and ≥30 minutes increased,while the number of people sleep latency in 10～ minutes decreased.The number of people sleep time <6 hours and ≥9 hours increased,and the number of people sleep time in 6～ hours decreased.Compared with baseline,the number of passive smokers and range hood users increased during follow-up,but the difference was not statistically significant(P > 0.05).Multivariate logistic regression showed that the change of smoking behavior in high-risk groups was related to gender,sleep time,occupational exposure,baseline LDCT test results and other factors.The change of passive smoking behavior was related to the gender,occupation,education level and sleep latency of the subjects.The change in physical activity behavior was related to factors such as occupation,alcohol consumption and sleep time.For 839 patients with pulmonary nodules,614 LDCT reports were collected after two-year follow-up,with a follow-up rate of 73.2%.Among them,314(51.1%)had stable nodules,201(32.7%)had nodules progression,and 99(16.1%)had nodules improvement.The results of logistic regression showed that age,occupational exposure and family history of lung cancer were statistically significant in the progressive group compared with the stable group.Nodules progression was more likely in participants aged 60～ years than in those aged 50～ years(OR=1.76,95%CI: 1.14-2.72).Nodule progression was more likely in occupational exposed subjects than in those without occupational exposure(OR=1.48,95% CI: 1.01-2.16).Nodule progression was more likely with a family history of lung cancer than without(OR=1.91,95%CI: 1.19-3.06).Malignant tumor history and sleep time were statistically significant in the improved group compared with the stable group.Nodules improvement was more likely with a history of malignancy than with no history of malignancy(OR=5.71,95% CI:2.06-15.86).Nodule improvement was more likely at whose sleep time <6 hours than those sleep time 6 to 8 hours.(OR=2.32,95% CI: 1.09-4.96).ConclusionsFactors such as gender,occupation,education level,occupational exposure and baseline LDCT examination results are closely related to the change of living habits and behavior patterns of the survey subjects.Ages,occupational exposure,history of malignancy,family history of lung cancer and sleep time are the important factors affecting the outcome of pulmonary nodules.In the follow-up lung cancer screening,we can focus on the relevant population,develop targeted intervention measures,do a good job in relevant knowledge popularization and behavior guidance,and change their bad lifestyle and behavior habits,thereby improving the health of the population. |
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