- 學位論文
高雄市婦女罹患慢性支氣管炎之環境危險因子
Risk factors of female chronic bronchitis in Kaohsiung city
摘要
研究背景與目的：抽菸為罹患慢性支氣管炎之主要危險因子。然而根據2004年行政院衛生署國民健康局的統計，台灣地區成年男性吸菸率45.9%，可是成年女性吸菸率只有6.1%，可見尚有其它環境危險因子會導致慢性支氣管炎。因此本研究目的為探討導致台灣女性罹患慢性支氣管炎的危險因子。 材料與方法：本研究是以社區巢式病例對照研究法。病例組與對照組均來自高屏地區中央健保局民國八十九年度一月至十二月的健保資料中40歲以上(包括40歲)女性，且居住在高雄市五年以上。病例組在研究期間被醫師診斷為慢性支氣管炎(ICD-9 code：491)至少兩次，且排除其它呼吸道疾病，對照組為在研究期間，曾因為交通意外(ICD-9 code：E800~E848)或急性腸胃炎(ICD-9 code：008.8；009.1；558.3；558.9)就醫，排除其它呼吸道肺部疾病。個案進行實際問卷訪視和肺功能檢查。 結果：本研究計劃持續進行中，由民國九十一年七月至九十四年二月為止，總共完成210位病例組及210位對照組訪視，本研究以問卷結果(美國胸腔協會訂定的慢性支氣管炎的臨床診斷症狀)，探討分析。研究結果回答有咳嗽或咳痰症狀有36位，有377位回答無咳嗽或咳痰症狀及有7位回答不知道。在20-40歲時期有咳嗽或咳痰者(n=36)有6位(16.7%)有抽菸習慣、23位(63.9%)二手菸暴露及7位(19.4%)無抽菸及二手菸暴露；而無症狀者(n=377)中有15位(4.0%)有抽菸、225位 (59.7%)二手菸暴露及137位(36.3%)無二手菸暴露，調整年齡、BMI、教育程度、下廚習慣及拜香習慣後，有二手菸或抽菸習慣的婦女相較於同時無抽菸及二手菸暴露者，分別有2.11倍(95% CI=0.85-5.21)與8.44倍(95%CI=2.42-29.5)危險性會導致咳嗽或咳痰症狀；綜合20-40歲時期及40歲以後兩個時期為一生暴露，有症狀組(n=36)有8位(22.2%)有抽菸習慣、23位(63.9%)二手菸暴露及5位(13.9%)無抽菸及二手菸暴露；而無症狀者(n=377)中有18位(4.8%)有抽菸、233位 (61.8%)二手菸暴露及126位(33.4%)無二手菸暴露，一生有二手菸暴露或抽菸習慣的婦女調整後分別有2.5倍(95% CI=0.93-6.79)及11.3倍(95% CI=3.26-39.2)危險性會導致咳嗽或咳痰症狀。另外探討下廚與排油煙機使用情形，排除未下廚習慣53位，發現在20-40歲時期有咳嗽或咳痰者(n=33)，有23(69.7%)位下廚習慣的婦女家中未裝設排油煙機；而無症狀者(n=327)中有172位(50.9%)下廚習慣的婦女家中未裝設排油煙機，調整年齡、BMI、教育程度、菸暴露情形及拜香習慣後，未裝設排油煙機相較於有裝設者有2.41倍(95%CI=0.92-6.30)危險性會導致咳嗽或咳痰症狀；而一生時期有症狀組(n=33)皆沒有安裝排油煙機有3(9.1%)位、20-40歲時期或40之後時期後才安裝排油煙機20 (60.6%)位；而無症狀者(n=327)中有12位(3.7%)一生皆未安裝排油煙機、20-40歲時期或40之後時期後才安裝排油煙機160 (48.9%)位，調整後，一生皆未安裝排油煙機及20-40歲時期或40之後時期後才安裝排油煙機者分別有5.70倍(95%CI= 1.00-32.60)和2.10倍(95%CI= 0.83-5.49) 危險性會導致咳嗽或咳痰症狀(p value< 0.044 for trend test)。 本研究也發現抽菸、二手菸暴露、家中未安裝抽油煙機與燒香拜拜習慣是造成婦女FEV1下降的主要危險因子。 結論：本研究結果顯示抽菸為罹患慢性支氣管炎的危險因子，有下廚習慣，但是未裝設排油煙機時，可能會增加婦女罹患慢性支氣管炎的危險因子；同時發現危險因子，抽菸、二手菸暴露、燒香暴露、未裝設排油煙機，會明顯降低肺功能。
並列摘要
Although cigarette smoking is a major risk factor for chronic bronchitis, only 6.1% of female were smokers in Taiwanese women. Therefore, the purpose of this study is to investigate the effect of other environmental risk factors, besides cigarette smoking, on chronic bronchitis risk in Taiwanese women. This is a community–based nested case-control study design. The potential study subjects were from the data bank of National Health Insurance in Kaohsiung area between Jan., and Dec., 2000. Eligible cases and controls were female who were 40 years old and over and had lived in Kaohsiung City for 5 years and over. Potential study cases were those diagnosed with chronic bronchitis (ICD-9 code: 491) at least twice and without other respiratory diseases in Year 2000. Potential controls were those who suffered from traffic accident ( ICD-9 code : E800~E848) or acute gastroenteritis ( ICD -9 code : 008.8; 009.1; 558.3; 558.9) and were without chronic bronchitis and other respiratory diseases. Between Jul., 2000, and Feb., 2005, 210 potential cases and 210 potential controls completed the questionnaires and pulmonary function tests. Among them, 36 and 377 participants were diagnosed with and without, respectively, chronic bronchitis on the basis of American Thoracic Society (ATS) criteria. Seven participants had lack of information about their status of chronic bronchitis. Among the 36 chronic bronchitis women, 6 (16.7%) were cigarette smokers, 23 (63.9%) were exposed environmental tobacco smoke (ETS), and 7 (19.4%) were non-smoker and non-ETS exposure at aged 20-40 years. In contrast, among the 377 women without the symptoms of cough or cough with productive sputum, 15 (4.0%) were cigarette smokers, 225 (59.7%) were exposed ETS, and 137 (36.3%) were non-smoker and non-ETS exposure. Compared to non-smokers, women with ETS exposure and cigarette smoking at aged 20-40 years had 2.11 (95% CI = 0.85 to 5.21) and 8.44 (95% CI = 2.42 to 29.5), respectively, to develop chronic bronchitis, defined by ATS criteria, after adjusting for other co-variates. The similar results were found in the lifetime ETS exposure and cigarette smoking. To explore the influence of cooking oil fume exposure on chronic bronchitis risk, we excluded 53 women who did not cook at aged 20-40 years. Among the 33 and 327 women with and without chronic bronchitis, 3 (69.7%) and 172 (50.9%) did not install the fume extractor at their home. The risk ratio was 2.41 (95% CI = 0.92-6.30) for the women who did not install the fume extractor at home at aged 20-40 years, after adjusting for other co-variates. We also found a joint protective effect of fume extractor use if study women used the extractors during both periods of their life, 20-40 and > 40 years. Our results suggest, besides cigarette smoking, ETS and cooking oil fume exposures were also the major risk factors of chronic bronchitis among Taiwanese women.