Healthy lifestyle behaviors among individuals with chronic obstructive pulmonary disease in urban and rural communities in China: a large community-based epidemiological study

Abstract

Background

Lifestyle modification is one of the most cost-effective strategies in self-management and secondary prevention of chronic obstructive pulmonary disease (COPD). However, the prevalence of healthy lifestyle behaviors in COPD patients in China remains unclear. The objective of this study was to examine the rates of healthy lifestyle behaviors including smoking cessation, regular exercise, and healthy diet in community population with COPD in China.

Methods

We recruited 46,285 individuals aged 35–70 years from 115 urban and rural communities in 12 provinces of China from 2005 to 2009. We recorded the smoking status, physical activity intensity, and quality of diet for all spirometry-diagnosed COPD patients by standardized questionnaires.

Results

Among 3,690 individuals with COPD, 18.2% (95% confidence interval [CI], 13.0–24.9) quitted smoking, 27.1% (95% CI, 24.7–29.7) exercised often, and 34.8% (95% CI, 31.8–38.0) ate high-quality diet. More than half of the individuals followed one or less key healthy lifestyle, and only 8.4% (95% CI, 7.0–10.0) followed all of the three healthy behaviors. Urban residents had significant higher rates of smoking cessation (23.5% [95% CI, 17.3–31.1] vs 14.4% [95% CI, 9.9–20.5], p=0.0008), regular exercise (45.6% [95% CI, 42.4–48.8] vs 14.0% [95% CI, 12.1–16.2], p<0.0001), and healthy diet (38.5% [95% CI, 35.5–41.6] vs 32.2% [95% CI, 29.2–35.4], p=0.0013) than rural residents. Age, sex, education level, body mass index, respiratory symptoms, and family income were associated with healthy living, and the strength of associations varied between urban and rural areas.

Conclusion

There is a large gap between the anticipated rate and the real participation in healthy lifestyle behaviors in Chinese adults with COPD, especially in rural communities. Simple and effective strategies are warranted to improve patients’ lifestyle in China.

Keywords:

• COPD
• lifestyle
• smoking cessation
• physical activity
• diet

Acknowledgments

PURE-China Study was supported by a grant from the Population Health Research Institute, Hamilton, Ontario, Canada, which administered the funds received from a variety of sources, including the Canadian Institutes of Health Research, Heart and Stroke Foundation of Ontario, unrestricted grants from several pharmaceutical companies, and grants from the National Center for Cardiovascular Diseases, People’s Republic of China.

PURE-China investigators (**national coordinator; *regional coordinator)

China coordination center

Lisheng Liu,** Wei Li,** Bing Liu, Bo Hu, Chunming Chen, Jin Guo, Hongye Zhang, Hui Chen, Jian Bo, Jian Li, Juan Li, Jun Yang, Kean Wang, Li Zhang, Qing Deng, Bing Ren, Tao Chen, Tao Xu, Wei Wang, Wenhua Zhao, Xiaohong Chang, Xiaoru Cheng, Xinye He, Xixin Hou, Xingyu Wang, Xiulin Bai, Xiuwen Zhao, Xu Liu, Xuan Jia, Yang Wang, Yi Sun, Yi Zhai.

Beijing

Dong Li,* Di Chen,* Hui Jin, Jiwen Tian, Yumin Ma (Jishuitan Hospital); Yindong Li,* Chao He, Kai You, Songjian Zhang (Center for Disease Control and Prevention, Shunyi District); Xiuzhen Tian,* Xu Xu,* Jinling Di, Jianquan Wu, Mei Wang, Qiang Zhou (Hospital of T.C.M.S, Shijingshan District).

Inner Mongolia autonomous region

Shiying Zhang,* Aiying Han, Minzhi Cao (Center for Disease Control and Prevention, Bayannaoer).

Jiangsu province

Jianfang Wu,* Weiping Jiang,* Deren Qiang, Jing Qin, Shan Qian, Suyi Shi, Yihong Zhou (Center for Disease Control and Prevention, Wujin District, Changzhou); Zhenzhen Qian,* Zhengrong Liu (Centers for Disease Control and Prevention); Changlin Dong,* Ming Wan (Jiangxinzhou Community Health Service Center, Jianye District, Nanjing); Jun Li,* Jinhua Tang (Jianye Hospital, Nanjing); Jun Li* (Xiaohang Hospital, Nanjing); Yongzhen Mo,* Rongwen Bian, Qinglin Lou (Nanhu Community Health Service Center, Jianye District, Nanjing).

Jiangxi province

Rensheng Lei,* Lihua Hu, Shuwei Xiong, Yan Zhong (Center for Disease Control and Prevention, Nanchang); Ning Li,* Xincheng Tang,* Shuli Ye (Qingshan Lake Community Health Service Center, Nanchang).

Liaoning province

Yu Liu,* Chunyi Li, Yujin Li (242 Hospital, Shenyang); Minfan Fu,* Qiuyuan Wang, Xiaoli Fu (Center for Disease Control and Prevention, Daxing District, Shenyang); Xiaojie Xing,* Baoxia Guo,* Huilian Feng, Lihui Xu (Red Cross Hospital, Shenyang).

Qinghai province

Yuqing Yang,* Haibin Ma, Ruiqi Wu, Yali Wang (Center for Disease Control and Prevention, Xining); Xiaolan Ma,* Hongze Liu, Yurong Ma (Huizu Hospital, Xining).

Sichuan province

Xiaoyang Liao,* Bo Yuan, Qian Zhao (West China Hospital, Sichuan University, Chengdu); Guofan Xu,* Hui He, Jiankang Liu, Xin Wang (Jianshe Road Community Health Center, Chengdu); Ming Chen,* Wenqing Deng* (Center for Disease Control and Prevention, Dayicaichang County, Chengdu).

Shandong province

Fanghong Lu,* Zhendong Liu,* Hua Zhang, Shangwen Sun, Shujian Wang, Yingxin Zhao, Yutao Diao (Cardiovascular Disease Research Institute, Jinan); Mei Wang,* Xuezheng Shi (Qiluhuayuan Hospital, Jinan); Debin Ren,* Chuanrui Wei (Department of Public Health, Zhangqiu).

Shanxi province

Liangqing Zhang,* Jufang Wang (Cardiovascular Disease Hospital, Taiyuan); Lianghou Fan,* Guoqin Liu (Peoples Hospital, Jingle); Yan Hou,* Cuiying Wu, Guilan Ma, Hua Wei, Junying Wang, Xiongfei Bao, Yue Tang (Balingqiao Community Health Service Center, Xinghualing District, Taiyuan).

Shaanxi province

Tianlu Liu,* Yahong Zhi; Peng Zhang,* Ailing Wang, Huijuan Wang, Jianna Liu (Guanshan Town Hospital, Yanliang District, Xi’an); Qinzhou Liu,* Rong Wang (Hospital of Xidian University, Xi’an).

Xinjiang uygur autonomous region

Jianguo Wu,* Aideer.Aili,* Ayoufumiti.Wula, Aibi.Bula, Dongmei Yang, Qian Wen, Resha.Laiti (Center for Disease Control and Prevention, Hetian).

Yunnan province

Yize Xiao,* Qingping Shi, Ying Shao (Center for Disease Control and Prevention); Jing He,* Kehua Li, Wuba Bai, Jinkui Yang (Center for Disease Control and Prevention, Damenglong County, Xishuangbanna); Yunchun Jiang,* Huaxing Liu,* Shunyun Yang (Center for Disease Control and Prevention, Mengla County, Xishuangbanna).

Disclosure

The authors report no conflicts of interest in this work.