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目的验证中国宣威县家庭燃煤炉的改造对慢性阻塞性肺病(COPD)发病率的影响。设计方法回顾性队列研究(随访时间1976至1992年),比较有烟囱组和无烟囱组COPD发病率的差异。研究对象20453名参与者出生在没有安装排烟系统的家庭中,其中16606人(81.2%)后来家中的燃煤炉安装了烟囱。干预在既往没有安装排风系统的家庭中安装烟囱。结果给燃煤炉加装烟囱与COPD的发病率降低显著相关。与家中没有安装烟囱的参与者相比,Cox模型计算的男性相对危险度(RR)为0·58(95%可信区间0.49~0.70,P<0.001);女性相对危险度为0.75(95%可信区间0.62~0·92,P=0.005)。Cox模型的设定不同,计算出的相对危险度也是不同的。改炉改灶的年限越长,COPD的相对危险度越低。无论男性和女性,改灶后10年内COPD发病危险性下降都非常明确。结论宣威居民COPD的发病率随着家庭燃煤炉改造后年限增加而显著降低。
Objective To verify the effect of the reconstruction of a domestic coal-fired stove in Xuanwei County, China, on the incidence of chronic obstructive pulmonary disease (COPD). Design Methods Retrospective cohort study (follow-up from 1976 to 1992) was performed to compare the incidence of COPD between the chimney group and the chimney-free group. Subjects 20 453 participants were born in families without a smoke extraction system, of which 16,606 (81.2%) later installed their own coal-fired stoves in their homes. Intervention Install chimneys in homes that did not have an exhaust system installed. As a result, there was a significant correlation between the addition of chimneys to coal-fired stoves and the reduced incidence of COPD. The relative risk (RR) for males calculated by Cox was 0.58 (95% confidence interval 0.49 to 0.70; P <0.001), compared with participants who did not have chimneys in their homes. The relative risk for females was 0.75 (95% Confidence interval 0.62 ~ 0.92, P = 0.005). The Cox model is set differently, and the calculated relative risk is also different. The longer the stove to change the stove, the lower the relative risk of COPD. Both men and women, 10 years after the change in the risk of COPD declines in the risk are very clear. Conclusions The incidence of COPD in Sherwin-Williams residents decreased significantly with the increase of years after the renovation of the domestic coal-fired stoves.