Geographical Variation of COPD Mortality and Related Risk Factors in Jiading District, Shanghai

Abstract

Background: Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death in China. Although numerous studies have been conducted to determine the risk factors for COPD mortality such as ambient air pollution, the results are not fully consistent.Methods: This study included mortality analysis and a case-control design by using the data extracted from the Mortality Registration System in Jiading District, Shanghai. Traditional logistic regression, geographically weighted logistic regression (GWLR), and spatial scan statistical analysis were performed to explore the geographic variation of COPD mortality and the possible influencing factors.Results: Traditional logistic regression showed that extreme lower temperature in the month prior to death, shorter distance to highway, lower GDP level were associated with increased COPD mortality. GWRL model further demonstrated obvious geographical discrepancies for the above associations. We additionally identified a significant cluster of low COPD mortality (OR = 0.36, P = 0.002) in the southwest region of Jiading District with a radius of 3.55 km by using the Bernoulli model. The geographical variation in age-standardized mortality rate for COPD in Jiading District was explained to a certain degree by these factors.Conclusion: The risk of COPD mortality in Jiading District showed obvious geographical variation, which were partially explained by the geographical variations in effects of the extreme low temperature in the month prior to death, residential proximity to highway, and GDP level.

Residential proximity to main road and the risk of COPD

“…Their study showed a significant association between proximity to main roads and prevalence of COPD, suggesting that proximity to road traffic may be a risk factor for developing COPD. Similar observations have been reported in the past from France,[ 2 ] Japan,[ 3 ] China,[ 4 ] and Germany. [ 5 ] Several studies have shown that, residing close (<100 m) to a major road has a detrimental effect on lung function and can increase the risk of allergic diseases and asthma.…”

Geographical Differences and Their Associated Factors in Chronic Obstructive Pulmonary Disease Mortality in Japan: An Ecological Study Using Nationwide Data

“…Geographical differences in COPD incidence, mortality, and prevalence have been reported in other countries [16][17][18][19][20][21], and factors associated with these regional differences have been identified. A study in Taiwan has reported that factors such as smoking prevalence, percentage of aborigines, and concentration of particulate matter 10 are positively associated with regional COPD mortality rate [20], and another study in China has showed that smoking and exposure to particulate matter 2.5 are positively associated with COPD prevalence [18].…”

“…A study in Taiwan has reported that factors such as smoking prevalence, percentage of aborigines, and concentration of particulate matter 10 are positively associated with regional COPD mortality rate [20], and another study in China has showed that smoking and exposure to particulate matter 2.5 are positively associated with COPD prevalence [18]. Another study that investigated factors associated with COPD mortality in Shanghai has revealed that extremely low temperatures in the month before death, shorter distances to the highway, and lower gross domestic product are associated with mortality [21]. Therefore, socioeconomic and environmental characteristics are particularly associated with regional COPD mortality or prevalence in other countries.…”