{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T22:21:35Z","timestamp":1785450095321,"version":"3.56.0"},"reference-count":45,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,12,8]],"date-time":"2023-12-08T00:00:00Z","timestamp":1701993600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100012166","name":"National Key Research and Development Program of China","doi-asserted-by":"publisher","award":["2016YFC1304000"],"award-info":[{"award-number":["2016YFC1304000"]}],"id":[{"id":"10.13039\/501100012166","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Chronic obstructive pulmonary disease (COPD) has become one of the most significant chronic diseases in China. According to conventional wisdom, smoking is the pathogenic factor. However, current research indicates that the pathophysiology of COPD may be associated with prior respiratory system events (e.g., childhood hospitalization for pneumonia, chronic bronchitis) and environmental exposure (e.g., dust from workplace, indoor combustion particles). Dyspnea, persistent wheezing, and other respiratory symptoms further point to the need for pulmonary function tests in this population. Reducing the burden of chronic diseases in China requires a thorough understanding of the various factors that influence the occurrence of COPD.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Using a cohort from the natural population, this study used nested case-control analysis. We carried out a number of researches, including questionnaire surveys and pulmonary function testing, in the Northwest and Southeast cohorts of China between 2014 and 2021. After removing any variations in the baseline data between patients and control subjects using propensity score matching analysis, the risk factors were examined using univariate or multivariate regression.<\/jats:p><\/jats:sec><jats:sec><jats:title>Result<\/jats:title><jats:p>It was discovered that prior history of chronic bronchitis, long-term wheezing symptoms, and environmental exposure\u2014including smoking and biofuel combustion\u2014were risk factors for COPD. Dyspnea, symptoms of mobility limitation, organic matter, and a history of hospitalization for pneumonia at an early age were not significant in the clinical model but their incidence in COPD group is higher than that in healthy population.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>COPD screening effectiveness can be increased by looking for individuals with chronic respiratory symptoms. Smokers should give up as soon as they can, and families that have been exposed to biofuels for a long time should convert to clean energy or upgrade their ventilation. Individuals who have previously been diagnosed with emphysema and chronic bronchitis ought to be extra mindful of the prevention or advancement of COPD.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2023.1303097","type":"journal-article","created":{"date-parts":[[2023,12,8]],"date-time":"2023-12-08T12:31:23Z","timestamp":1702038683000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":5,"title":["An investigation of the risk factors of chronic obstructive pulmonary disease in natural population-based cohorts in China \u2013 a nested case-control study"],"prefix":"10.3389","volume":"11","author":[{"given":"Yixin","family":"Xu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongjun","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chunchun","family":"Yu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuqian","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hao","family":"Xu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhe","family":"Weng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chengshui","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haizhou","family":"Mao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,12,8]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1341","DOI":"10.1016\/s0140-6736(11)60968-9","article-title":"Chronic obstructive pulmonary disease","volume":"379","author":"Decramer","year":"2012","journal-title":"Lancet"},{"key":"ref2","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph191710896","article-title":"Metal exposure, smoking, and the risk of COPD: a nested case-control study in a Chinese occupational population","volume":"19","author":"Ma","year":"2022","journal-title":"Int J Environ Res Public Health"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"753","DOI":"10.1164\/rccm.200612-1749OC","article-title":"Prevalence of chronic obstructive pulmonary disease in China: a large, population-based survey","volume":"176","author":"Zhong","year":"2007","journal-title":"Am J Respir Crit Care Med"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"1706","DOI":"10.1016\/s0140-6736(18)30841-9","article-title":"Prevalence and risk factors of chronic obstructive pulmonary disease in China (the China pulmonary health [CPH] study): a national cross-sectional study","volume":"391","author":"Wang","year":"2018","journal-title":"Lancet"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"859499","DOI":"10.3389\/fpubh.2022.859499","article-title":"The burden of COPD in China and its provinces: findings from the global burden of disease study 2019","volume":"10","author":"Yin","year":"2022","journal-title":"Front Public Health"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"557","DOI":"10.1164\/rccm.201701-0218PP","article-title":"Global strategy for the diagnosis, management, and prevention of chronic obstructive lung disease 2017 report. GOLD executive summary","volume":"195","author":"Vogelmeier","year":"2017","journal-title":"Am J Respir Crit Care Med"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1183\/09059180.00007212","article-title":"Smoking cessation and COPD","volume":"22","author":"T\u00f8nnesen","year":"2013","journal-title":"Europ Respirat Rev"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"1203","DOI":"10.2147\/copd.S301579","article-title":"Adherence and efficacy of smoking cessation treatment among patients with COPD in China","volume":"16","author":"Qin","year":"2021","journal-title":"Int J Chron Obstruct Pulmon Dis"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"1384","DOI":"10.1289\/ehp236","article-title":"Cooking coal use and all-cause and cause-specific mortality in a prospective cohort study of women in Shanghai","volume":"124","author":"Kim","year":"2016","journal-title":"China Environ Health Persp"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"111739","DOI":"10.1016\/j.envres.2021.111739","article-title":"Occupational exposure to particles and increased risk of developing chronic obstructive pulmonary disease (COPD): a population-based cohort study in Stockholm, Sweden","volume":"200","author":"Grahn","year":"2021","journal-title":"Environ Res"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"e1001621","DOI":"10.1371\/journal.pmed.1001621","article-title":"Lung function and incidence of chronic obstructive pulmonary disease after improved cooking fuels and kitchen ventilation: a 9-year prospective cohort study","volume":"11","author":"Zhou","year":"2014","journal-title":"PLoS Med"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"992","DOI":"10.1378\/chest.13-1429","article-title":"Effect of occupational exposure to vapors, gases, dusts, and fumes on COPD mortality risk among Swedish construction workers: a longitudinal cohort study","volume":"145","author":"Tor\u00e9n","year":"2014","journal-title":"Chest"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"277","DOI":"10.1081\/COPD-57610","article-title":"The burden of obstructive lung disease initiative (BOLD): rationale and design","volume":"2","author":"Buist","year":"2005","journal-title":"COPD"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"421","DOI":"10.1016\/s2213-2600(18)30103-6","article-title":"Chronic obstructive pulmonary disease in China: a nationwide prevalence study","volume":"6","author":"Fang","year":"2018","journal-title":"Lancet Respir Med"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"e70","DOI":"10.1164\/rccm.201908-1590ST","article-title":"Standardization of spirometry 2019 update. An official American thoracic society and European respiratory society technical statement","volume":"200","author":"Graham","year":"2019","journal-title":"Am J Respir Crit Care Med"},{"key":"ref16","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.00239-2023","article-title":"Global initiative for chronic obstructive lung disease 2023 report: GOLD executive summary","volume":"61","author":"Agust\u00ed","year":"2023","journal-title":"Eur Respir J"},{"key":"ref17","year":"2023"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"16059","DOI":"10.1038\/npjpcrm.2016.59","article-title":"Should the diagnosis of COPD be based on a single spirometry test?","volume":"26","author":"Schermer","year":"2016","journal-title":"NPJ Primary Care Respirat Med"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"323","DOI":"10.1111\/j.1440-1843.2005.00720.x","article-title":"Comparison of existing symptom-based questionnaires for identifying COPD in the general practice setting","volume":"10","author":"van Schayck","year":"2005","journal-title":"Respirology"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"285","DOI":"10.1159\/000090142","article-title":"Symptom-based questionnaire for identifying COPD in smokers","volume":"73","author":"Price","year":"2006","journal-title":"Respiration"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"00960","DOI":"10.1183\/23120541.00960-2020","article-title":"Dyspnoea and symptom burden in mild-moderate COPD: the Canadian cohort obstructive lung disease study","volume":"7","author":"Cherian","year":"2021","journal-title":"ERJ Open Res"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"3323","DOI":"10.2147\/copd.S150243","article-title":"Smoking cessation affects the natural history of COPD","volume":"12","author":"Bai","year":"2017","journal-title":"Int J Chron Obstruct Pulmon Dis"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"497","DOI":"10.1016\/s2213-2600(21)00506-3","article-title":"Chronic obstructive pulmonary disease in never-smokers: risk factors, pathogenesis, and implications for prevention and treatment","volume":"10","author":"Yang","year":"2022","journal-title":"Lancet Respir Med"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"909","DOI":"10.1378\/chest.11-2884","article-title":"Secondhand smoke exposure predicted COPD and other tobacco-related mortality in a 17-year cohort study in China","volume":"142","author":"He","year":"2012","journal-title":"Chest"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"115","DOI":"10.1186\/s12931-015-0273-8","article-title":"Childhood pneumonia increases risk for chronic obstructive pulmonary disease: the COPDGene study","volume":"16","author":"Hayden","year":"2015","journal-title":"Respir Res"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"1353","DOI":"10.2147\/copd.S161555","article-title":"Disease burden of COPD in China: a systematic review","volume":"13","author":"Zhu","year":"2018","journal-title":"Int J Chron Obstruct Pulmon Dis"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"447","DOI":"10.1016\/s2213-2600(21)00511-7","article-title":"Global, regional, and national prevalence of, and risk factors for, chronic obstructive pulmonary disease (COPD) in 2019: a systematic review and modelling analysis","volume":"10","author":"Adeloye","year":"2022","journal-title":"Lancet Respir Med"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"106841","DOI":"10.1016\/j.envint.2021.106841","article-title":"A critical review of pollutant emission factors from fuel combustion in home stoves","volume":"157","author":"Shen","year":"2021","journal-title":"Environ Int"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"1050","DOI":"10.1136\/bmj.38628.676088.55","article-title":"Improvement in household stoves and risk of chronic obstructive pulmonary disease in Xuanwei, China: retrospective cohort study","volume":"331","author":"Chapman","year":"2005","journal-title":"BMJ"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"57008","DOI":"10.1289\/ehp2856","article-title":"Solid fuel use and incident COPD in Chinese adults: findings from the China Kadoorie biobank","volume":"127","author":"Li","year":"2019","journal-title":"Environ Health Perspect"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"501","DOI":"10.1093\/ije\/dyab191","article-title":"Solid fuel use, socioeconomic indicators and risk of cardiovascular diseases and all-cause mortality: a prospective cohort study in a rural area of Sichuan","volume":"51","author":"Qiu","year":"2022","journal-title":"China Int J Epidemiol"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"848","DOI":"10.1289\/ehp.9479","article-title":"Household air pollution from coal and biomass fuels in China: measurements, health impacts, and interventions","volume":"115","author":"Zhang","year":"2007","journal-title":"Environ Health Perspect"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"399","DOI":"10.1111\/resp.14272","article-title":"Occupational COPD-the most under-recognized occupational lung disease?","volume":"27","author":"Murgia","year":"2022","journal-title":"Respirology"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"126","DOI":"10.1097\/ACI.0b013e3283511d0e","article-title":"Immunological and inflammatory responses to organic dust in agriculture","volume":"12","author":"Poole","year":"2012","journal-title":"Curr Opin Allergy Clin Immunol"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1186\/s13601-020-00334-x","article-title":"Respiratory diseases and allergy in farmers working with livestock: a EAACI position paper","volume":"10","author":"Sigsgaard","year":"2020","journal-title":"Clin Transl Allergy"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"725","DOI":"10.2147\/copd.S125980","article-title":"Occupational COPD and job exposure matrices: a systematic review and meta-analysis","volume":"12","author":"Sadhra","year":"2017","journal-title":"Int J Chron Obstruct Pulmon Dis"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"1602470","DOI":"10.1183\/13993003.02470-2016","article-title":"Epidemiology and impact of chronic bronchitis in chronic obstructive pulmonary disease","volume":"50","author":"Lahousse","year":"2017","journal-title":"Eur Respir J"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"228","DOI":"10.1164\/rccm.201210-1843CI","article-title":"Chronic bronchitis and chronic obstructive pulmonary disease","volume":"187","author":"Kim","year":"2013","journal-title":"Am J Respir Crit Care Med"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"683","DOI":"10.2147\/copd.S153555","article-title":"Early life insults as determinants of chronic obstructive pulmonary disease in adult life","volume":"13","author":"Savran","year":"2018","journal-title":"Int J Chron Obstruct Pulmon Dis"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"93","DOI":"10.1016\/j.tcm.2019.12.009","article-title":"Lung function and cardiovascular disease: a link","volume":"31","author":"Ramalho","year":"2021","journal-title":"Trends Cardiovasc Med"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1900\/rds.2019.15.1","article-title":"Diabetes and lung disease: a neglected relationship","volume":"15","author":"Khateeb","year":"2019","journal-title":"Rev Diabet Stud"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"1030","DOI":"10.3390\/medicina58081030","article-title":"Mechanisms linking COPD to type 1 and 2 diabetes mellitus: Is there a relationship between diabetes and COPD?","volume":"58","author":"Park","year":"2022","journal-title":"Medicina"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"2244","DOI":"10.1016\/j.chest.2021.01.004","article-title":"Protein biomarkers for COPD outcomes","volume":"159","author":"Serban","year":"2021","journal-title":"Chest"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"586","DOI":"10.1016\/j.scitotenv.2017.12.086","article-title":"Wildland fire smoke and human health","volume":"624","author":"Cascio","year":"2018","journal-title":"Sci Total Environ"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"e0264376","DOI":"10.1371\/journal.pone.0264376","article-title":"Common physiologic and proteomic biomarkers in pulmonary and coronary artery disease","volume":"17","author":"Casselbrant","year":"2022","journal-title":"PLoS One"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2023.1303097\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,12,8]],"date-time":"2023-12-08T12:31:33Z","timestamp":1702038693000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2023.1303097\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,12,8]]},"references-count":45,"alternative-id":["10.3389\/fpubh.2023.1303097"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2023.1303097","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,12,8]]},"article-number":"1303097"}}