心理困擾、生活型態與慢性阻塞性肺病及肺癌之病例對照研究

Association among psychological distress, lifestyle, and chronic obstructive pulmonary disease and lung cancer : case-control study.

丁珮珊(Pei-Shan Ting)

指導教授 ： 王理

中山醫學大學/健康管理學院/公共衛生學系碩士班/碩士(2011年)

https://doi.org/10.6834/CSMU.2011.00074

摘要

研究目的：本研究探討台灣民眾心理因素與生活型態及肺部疾病(慢性阻塞性肺病和肺癌)發生的關係。
研究背景：慢性阻塞性肺病及肺癌的肺部疾病在台灣是發生率及死亡率都非常高的疾病，因此了解慢性阻塞性肺病和肺癌發生的危險因子及其相關的心理因素，以為防範慢性阻塞性肺病及肺癌的肺部疾病是台灣公共衛生的重要課題。
材料方法：本研究是以醫院為基礎的病例對照研究，在中山醫學大學附設醫院收集病例組和對照組，慢性阻塞性肺病有151人、肺癌有51人及非肺部疾病有243人。以結構式問卷經由訪員透過面訪進行資料收集；以邏輯斯迴歸等統計方法進行資料分析。
研究結果：在慢性阻塞性肺病方面，性別、教育程度、經濟狀況、FVC、FEV1及FEV1/FVC會影響慢性阻塞性肺病的發生，飲酒、吸菸、二手菸、化學暴露、炸烤醃製肉類攝取及壓力會增加慢性阻塞性肺病發生的危險，而增加身體活動、飲茶、蔬果類和蛋豆類攝取均可降低罹患慢性阻塞性肺病的危險。多變項調整後，高度心理困擾是慢性阻塞性肺病發生的危險因子(AOR=4.58，95%CI=2.15-9.76)，且有劑量效應關係(P-trend<0.001)。心理因素與各危險因子雙變項分層後，在高心理困擾的情形下，目前飲酒(OR=8.36，95%CI=1.40-9.88)、目前吸菸(OR=6.08，95CI%=2.62-46.84)、二手菸(OR=6.46 ，95CI%=4.65-23.54)、中度身體活動(OR=4.42，95CI%=1.21-6.11)、每天少於1杯茶類攝取(OR=7.80，95CI%=5.48-29.92)、粉塵暴露(OR=4.67，95CI%=1.92-11.32)、化學暴露(OR=9.91，95CI%=4.60-21.32)、煮食(OR=5.46，95CI%= 4.80-18.67)、燒香(OR=6.09，95CI%=2.48-14.96)、肥胖(OR=6.98，95CI%=1.74-8.49)、高度壓力(OR=7.03，95CI%=4.00-25.00)、高度攝取炸烤醃製肉類(OR=6.46，95CI%=4.98-16.40)、低度攝取蔬果類(OR=5.95，95CI%=3.52-12.07)和低度攝取蛋豆類(OR=6.58，95CI%=3.57-12.70)均發現對於慢性阻塞性肺病的影響有顯著較高的危險。
　　在肺癌方面，性別和教育程度會影響肺癌的發生，吸菸、二手菸、肺癌家族史、炸烤醃製肉類攝取及壓力會增加肺癌發生的危險，而增加身體活動、飲茶和蔬果類攝取均可降低罹患肺癌的危險。多變項調整後，高度心理困擾是肺癌發生的危險因子(AOR=3.20，95%CI=2.00-13.51)且有劑量效應關係(P-trend=0.002)。心理因素與各危險因子雙變項分層後，在高心理困擾的情形下，未飲酒(OR=3.71，95CI%=3.04-19.51)、未吸菸(OR=4.42，95CI%=3.78-54.97)、二手菸暴露(OR=6.28，95CI%= 1.97-20.02)、低度身體活動(OR=3.79，95CI%=2.11-8.43)、每天低於1杯茶葉攝取(OR=8.37，95CI%=4.76-37.58)、化學暴露(OR=4.46，95CI%=3.41-14.11)、肥胖(OR=8.48，95CI%=2.33-30.82)、沒肺癌家族史(OR=4.60，95CI%=2.07-10.22)、高度壓力(OR=7.20，95CI%=1.94-26.70)、高度炸烤醃製肉類攝取(OR=3.85，95CI%=1.29-11.46)和低度蔬果類攝取(OR=4.86，95CI%=3.08-25.54)均發現對於肺癌的影響有顯著較高的危險。
結論：台灣民眾罹患慢性阻塞性肺病和肺癌受到生活型態及環境因子的影響，而有些因子與心理困擾因素相互影響提高慢性阻塞性肺病及肺癌的發生。

關鍵字

慢性阻塞性肺病 ； 肺癌 ； 心理困擾 ； 生活型態 ； 危險因子

並列摘要

Objective: The aim of this study is to examine the association between lung disease (chronic obstructive pulmonary disease, COPD, and lung cancer), lifestyle related risk factors, and psychological distress among the people of Taiwan.
Background: The incidence and mortality of COPD and lung cancer are high in Taiwan. It is very important for public health to understand COPD and lung cancer risk factors and their related psychological distress issues in preventing both of them.
Methods: This is a hospital-based paired case-control study. One hundred and fifty-one COPD patients, 51 lung cancer patients and 243 healthy controls were randomly recruited from Chung Shan Medical Hospital. Participant’s information was gathered through face-to-face interviews by an interviewer using a structured questionnaire to collect information. Statistical analysis was performed by logistic regression.
Results: In the COPD section, this study showed that sex, education, income, FVC, FEV1 and FEV1/FVC influenced the incidence of COPD. Alcohol consumption, smoking, exposure to passive smoking, exposure to chemicals, intake of fried, grilled and cured meats and high levels of stress would increase the risk of COPD. However, physical activity, tea, beans, vegetable and fruit consumption may reduce the risk of COPD. After adjusting confounding factors, high levels of psychological distress was also seen as a risk factor of COPD (AOR=4.58, 95%CI=2.15-9.76) with a significant trend (P<0.001). Bivariate stratified analyses showed that there is a significant positive association between high levels of psychological distress and COPD in patients, who also have higher levels of alcohol consumption (OR=8.36, 95%CI=1.40-9.88), smoking (OR=6.08, 95CI%=2.62-46.84), exposure to passive smoking (OR=6.46, 95CI%=4.65-23.54), moderate levels of physical activity (OR=4.42, 95CI%=1.21-6.11), drinking less than one cup of tea per day (OR=7.80, 95CI%=5.48-29.92), exposure to dust (OR=4.67, 95CI%=1.92-11.32), exposure to chemical (OR=9.91, 95CI%=4.60-21.32), cooking (OR=5.46, 95CI%=4.80-18.67), burning incense (OR=6.09, 95CI%=2.48-14.96), overweight (OR=6.98, 95CI%=1.74-8.49), high levels of stress (OR=7.03, 95CI%=4.00-25.00), high intake of fried, grilled and cured meats (OR=6.46, 95CI%=4.98-16.40), low intake of vegetables-fruits (OR=5.98, 95CI%=3.52-12.07) and low intake of beans (OR=6.58, 95CI%=3.57-12.70).　In the lung cancer section, this study demonstrated that sex and education influenced the incidence of lung cancer. Smoking, exposure to passive smoking, family history of lung cancer, intake of fried, grilled and cured meats, and stress would increase the risk factors of lung cancer. However, physical activity, tea, vegetable, and fruit consumption may reduce the risk of lung cancer. After adjusting confounding factors, high levels of psychological distress was concluded to be a risk factor of lung cancer (AOR=3.20, 95%CI=2.00-13.51) with a significant trend (P=0.002). Bivariate stratified analyses showed that there is a significant positive association between high levels of psychological distress and lung cancer in patients who also have high levels of alcohol consumption (OR=3.71, 95CI%=3.04-19.51), smoking(OR=4.42, 95C I%=3.78-54.97), exposure to passive smoking (OR=6.28, 95C I%=1.97-20.02), low levels of physical activity (OR=3.79, 95C I%=2.11-8.43), drinking less than one cup of tea daily (OR=8.37, 95C I%=4.76-37.58), exposure to chemical (OR=4.46, 95C I%=3.41-14.11), overweight (OR=8.48, 95C I%=2.33-30.82), family history of lung cancer(OR=4.60, 95C I%=2.07-10.22), high levels of stress (OR=7.20, 95C I%=1.94-26.70),high intake of fried, grilled and cured meats (OR=3.85, 95C I%=1.29-11.46) and low intake of vegetables-fruits (OR=4.86, 95C I%=3.08-25.54).
Conclusions: COPD and lung cancer are influenced by lifestyle and environmental risk factors in Taiwan. Some of those factors interact with psychological distress and would thereby increase the risk of COPD and lung cancer.

並列關鍵字

chronic obstructive pulmonary disease ； COPD ； lung cancer ； psychological distress ； lifestyle ； risk factors

參考文獻

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