Peipei Chen

Prevalence and correlations with depression, anxiety, and other features in outpatients with chronic obstructive pulmonary disease in China: a cross-sectional case control study

BackgroundPatients with chronic obstructive pulmonary disease (COPD) often experience depression and anxiety, but little information is available regarding Chinese patients with these conditions. The present study assessed depression and anxiety in Chinese patients with COPD.MethodsA case–controlled study was designed with 1100 patients with COPD enrolled in the case group and1100 residents without COPD and respiratory symptoms selected as the control group. Anxiety and depression in both groups were evaluated using the Hospital Anxiety and Depression Scale (HADS). The body mass index,degree of airflow obstruction, dyspnea, and exercise capacity (BODE ) index was used to assess COPD severity. Binary logistic regression models were used to test the association between anxiety and depression.ResultsThe patients with COPD were more likely than controls to experience depression (cases, HADS 10.5 ± 3.6, prevalence 35.7%; controls, HADS 8.7 ± 2.7, prevalence 7.2%) and anxiety (cases, HADS 10.4 ± 3.1, prevalence 18.3%; controls, HADS 8.6 ± 2.1, prevalence 5.3%). Subjects with anxious and depressive symptoms had poorer health outcomes including a higher BODE index, a shorter 6-minute-walk distance (6MWD), more dyspnea, and a higher St George’s respiratory questionnaire (SGRQ) score. The prevalence of anxious and depressive symptoms increased with increasing BODE scores. On the basis of binary logistic regression, the BODE index was significantly correlated with anxiety (OR = 1.47, p < 0.001) and depression (OR = 1.51, p < 0.001). Anxious and depressive symptoms were also associated with several factors including younger age, female sex, higher education level, lower household income and history of smoking.ConclusionsThis study confirmed the high prevalence of anxiety and depression in Chinese outpatients with COPD. Patients with COPD who had anxiety and/or depression had a poorer health-related quality of life.Trial registrationChinese Clinical Trials Registration(ChiCTR-TRC-12001958)

Relation of sleep quality and sleep duration to type 2 diabetes: a population-based cross-sectional survey

Objectives To investigate the association between self-reported sleep duration, sleep quality and the prevalence of diabetes in a contemporary sample of Chinese adults. Design Cross-sectional survey. Setting Community-based investigation in Xuzhou, China. Participants 16 893 Chinese men and women aged 18–75 who fulfilled the inclusion and exclusion criteria were enrolled. Primary and secondary outcome measures Self-reported quality and duration of sleep were obtained by questionnaire, and type 2 diabetes was assessed by fasting blood glucose. Sleep quality was categorised as good, common or poor. Sleep duration was measured by average hours of sleep per night, with categories of ≤6 h, 6–8 h and ≥8 h. A logistic regression model was used to evaluate the association between sleep duration or sleep quality and diabetes. Results Both poor quality of sleep and short sleep duration (≤6 h) were associated with increased prevalence of diabetes, with higher rates in relatively healthy Chinese people. Compared with the group with good quality of sleep and 6–8 h sleep duration, diabetes was the most prevalent in individuals with poor sleep quality and ≤6 h sleep duration (OR 1.41, 95% CI 1.07 to 1.85) and in those with poor sleep quality who slept ≥8 h (OR 1.39, 95% CI 0.85 to 2.26), even after adjustment for a large number of further possible factors. Conclusions The results suggest that sleep of poor quality and short duration is associated with diabetes.

Vulnerability, beliefs, treatments and economic burden of chronic obstructive pulmonary disease in rural areas in China: a cross-sectional study

BackgroundThe incidence of chronic obstructive pulmonary disease (COPD) in China is very high. This study aimed to assess the vulnerability of COPD patients in rural areas outside Xuzhou City, Jiangsu province, in order to provide helpful guidance for future research and public policies.MethodsThe vulnerability of 8,217 COPD patients was evaluated using a face-to-face questionnaire to obtain information on general characteristics, awareness, beliefs, medication usage, acute exacerbation of the disease, and economic burdens. Direct economic burdens were calculated based on the questionnaire, and indirect economic burdens were estimated using local per capita income and life expectancy in 2008. The years of potential life lost were calculated using loss of life years for each age group and multiplying by the number of deaths in a given age group.ResultsOf the 8,217 patients, 7,921 (96.4%) had not heard of COPD, and 2,638 (32.1%) did not understand that smoking was a risk factor for COPD. No patients had used inhalers, nebulizer drugs or oxygen therapy, either regularly or sporadically. No patients had undergone pulmonary rehabilitation or surgical treatment, while 4,215 (51.3%) took theophylline to relieve dyspnea, and 3,418 (41.6%) used antibiotics to treat exacerbations. A total of 2,925 (35.6%) patients had been admitted to hospital during the past year because of respiratory symptoms. The average direct and indirect economic burdens on COPD patients were 1,090 and 20,605 yuan, respectively.ConclusionsThe vulnerability of patients in rural Xuzhou to COPD was high. Their awareness of COPD was poor, their treatment during both the stable and acute exacerbation stages did not meet standards, and the economic burdens were large. Interventions are therefore needed to improve the prevention and management of COPD in this population. Further studies are required to verify these findings.

Interaction of sleep quality and sleep duration on impaired fasting glucose: a population-based cross-sectional survey in China

Objectives To explore the interactions of sleep quality and sleep duration and their effects on impaired fasting glucose (IFG) in Chinese adults. Design Cross-sectional survey. Setting Community-based investigation in Xuzhou, China. Participants 15 145 Chinese men and women aged 18–75 years old who fulfilled the inclusion criteria. Primary and secondary outcome measures The Pittsburgh Sleep Quality Index was used to produce sleep quality categories of good, common and poor. Fasting blood glucose levels were assessed for IFG. Sleep duration was measured by average hours of sleep per night, with categories of <6, 6–8 and >8 h. The products of sleep and family history of diabetes, obesity and age were added to the logistic regression model to evaluate the addictive interaction and relative excess risk of interaction (RERI) on IFG. The attributable proportion (AP) of the interaction and the synergy index (S) were applied to evaluate the additive interaction of two factors. Bootstrap measures were used to calculate 95% CI of RERI, AP and S. Results The prevalence of IFG was greatest in those with poor sleep quality and short sleep duration (OR 6.37, 95% CI 4.66 to 8.67; p<0.001) compared with those who had good sleep quality and 6–8 h sleep duration, after adjusting for confounders. After adjusting for potential confounders RERI, AP and S values (and their 95% CI) were 1.69 (0.31 to 3.76), 0.42 (0.15 to 0.61) and 2.85 (2.14 to 3.92), respectively, for the interaction between poor sleep quality and short sleep duration, and 0.78 (0.12 to 1.43), 0.61 (0.26 to 0.87) and −65 (−0.94 to −0.27) for the interaction between good sleep quality and long sleep duration. Conclusions The results suggest that there are additive interactions between poor sleep quality and short sleep duration.

Association of sleep quality and quality of life in type 2 diabetes mellitus: A cross-sectional study in China

OBJECTIVE The aim of this study is to investigate sleep quality and quality of life, and to assess the relationship between sleep quality and quality of life in Chinese patients with type 2 diabetes mellitus (T2DM). RESEARCH DESIGN AND METHODS 944 patients with T2DM were enrolled in our study. General characteristics and laboratory testing such as glycosylated hemoglobin A1c (HbA1c) were measured. Each patient completed a Chinese version of the Pittsburgh sleep quality index (PSQI) and the diabetes specificity quality of life scale (DSQL) questionnaires. A PSQI global score >7 was defined as poor sleep quality. A global DSQL score <40 was defined as a good quality of life. Multiple logistic regression analysis was used to examine the relationships between PSQI and DSQL. RESULTS Poor quality of life in participants was associated with a longer duration of diabetes, a greater number of diabetes complications, no alcohol drinking, poor glycemic control and having depression and anxiety (all P<0.001). Of the participants, 33.6% of them were poor sleepers according to their PSQI. Poor sleepers had significantly lower DSQL (P<001). After adjustment for confounders, poor sleep quality was positively associated with a lower health-related quality of life (OR: 3.67, 95% CI: 1.30-10.33, P<0.001). CONCLUSIONS Our results suggest that poor sleep is prevalent in T2DM and inversely associated with quality of life. It is necessary for primary health-care workers to include sleep related knowledge in diabetes self-management programs to improve sleep quality in diabetes patients.

Effects of Smoking, Depression, and Anxiety on Mortality in COPD Patients: A Prospective Study

BACKGROUND: Smoking, depression, and anxiety increase the risk of death in patients with COPD, but the combined effect of these factors is unknown. We assessed the interactive effects of smoking, depression, and anxiety on mortality in patients with COPD. METHODS: We collected and analyzed data from 7,787 subjects with COPD, in 14 rural communities, from May 2008 to May 2012, and used logistic regression to evaluate the interactions and relative excess risk due to interaction (RERI). We applied the attributable proportion of interaction and the synergy index to evaluate the additive interactions of the factors. RESULTS: In our COPD subjects the interaction of current smoking and depression symptoms increased the death risk by 3.8-fold (odds ratio 3.78, 95% CI 2.51–5.05), with significant biological interactions (RERI 1.74, 95% CI 0.51−2.99, attributable proportion 0.48, 95% CI 0.13–0.85, synergy index 2.98, 95% CI 1.44–4.56). The biological interactions increased with increasing years or pack-years of smoking: for subjects with ≥ 30 years of smoking: RERI 1.80, 95% CI 1.05–2.75, attributable proportion 0.48, 95% CI 0.15–0.82, synergy index 2.85, 95% CI 1.75–3.96; for subjects with ≥ 40 pack-years of smoking: RERI 3.11, 95% CI 1.54–4.71, attributable proportion 0.60, 95% CI 0.31–0.91, synergy index 4.00, 95% CI 2.84–5.26. Similarly, the combined effect of current smoking and anxiety symptoms increased the death risk by 4.3-fold (odds ratio 4.27, 95% CI 95% CI 2.96–5.59), with significant biological interactions (RERI 1.51, 95% CI 0.31–2.74, attributable proportion 0.46, 95% CI 0.11–0.87, synergy index 2.89, 95% CI 1.31–4.51). The biological interactions also increased with increasing years or pack-years of smoking: for subjects with ≥ 30 years of smoking: RERI 1.41, 95% CI 0.45–2.43, attributable proportion 0.45, 95% CI 0.12–0.81, synergy index 2.88, 95% CI 1.24–5.98; for subjects with ≥ 40 pack-years of smoking: RERI 3.15, 95% CI 2.07–4.61, attributable proportion 0.55, 95% CI 0.21–0.94, synergy index 3.00, 95% CI 1.45–4.75. CONCLUSIONS: Smoking, depression, and anxiety are associated with higher risk of death in patients with COPD. The risk of death, depression, and anxiety increases with increasing duration of smoking (years) and cigarette pack-years. Chinese Clinical Trials Registration ChiCTR-TRC-12001958.

Effects of sleep duration and sleep quality on prevalence of type 2 diabetes mellitus: A 5-year follow-up study in China.

OBJECTIVE To explore the interactions of sleep quality and sleep duration on the development of type 2 diabetes mellitus (DM2) in Chinese adults. RESEARCH DESIGN AND METHODS We randomly selected 11,842 Chinese subjects from the Xuzhou community of China and obtained self-reported quality and duration of sleep by questionnaire. DM2 was assessed by fasting blood glucose. Sleep quality was categorized as good, common, or poor. Sleep duration was measured by average hours of sleep per night. We evaluated interaction, relative excess risk of interaction (RERI), the attributable proportion (AP), and the synergy index (S) using a logistic regression model. RESULTS The relative risk for the development of DM2 was higher in subjects with short sleep duration (1.67 [1.34-2.16]) or poor sleep quality (1.91 [1.31-2.74]) or long sleep duration (1.45 [1.02-1.77]). DM2 occurred more frequently with poor sleep quality combined with short sleep duration (odds ratio: 6.21; 95% confidence interval (CI): 2.78-11.81). RERI, AP, and S values (and their 95% CI) were 3.99 (1.41-7.76), 0.64 (0.45-0.76), and 5.15 (3.74-7.89) for the interaction between poor sleep quality and short sleep duration. In subjects with poor sleep quality combined with long sleep duration, the RERI, AP, and S values (and 95% CI) were 0.13 (-0.19 to 0.66), 0.07 (-0.35 to 0.18), and 1.19 (0.85-2.11). CONCLUSIONS Interactions between poor sleep quality and short sleep duration were additive. Preventive measures should focus on short sleep duration and poor sleep quality.

Impact of risk factors, activities and psychological disorders on the health of patients with chronic obstructive pulmonary disease in China: a cross-sectional study

BackgroundPatients with chronic obstructive pulmonary disease (COPD) often have organ dysfunction and resulting poor quality of life; however, in China little information is available regarding factors that affect their health. Here, the relationship between risk factors, activities and psychological disorders and health of patients with COPD in rural areas of Xuzhou, China was assessed.MethodsA cross-sectional study of 7597 COPD patients randomly selected by place of residence from 24,641 COPD patients who had been identified by screening of the 1.10 million health records of all residents of the target area was carried out to evaluate the relationships between risk factors, activities, psychological disorders and the ADO index (age, dyspnea, and airflow obstruction). The participants were assessed by spirometry and by administering a newly designed face-to-face questionnaire, which included items on general factors, risk factors, activities and psychological disorders. Correlations between the ADO index and the items addressed by the questionnaire were calculated.ResultsThe mean score of the ADO index was 3.7 ± 1.6. The ADO indices of current smokers, ex-smokers, and non-smokers were 3.9 ± 2.1, 3.7 ± 1.9, and 3.2 ± 1.5, respectively (P < 0.001). The ADO indices of cooks and non-cooks were 4.0 ± 2.2 and 3.5 ± 1.7, respectively (P < 0.001). The correlation coefficient between self-assessment of health status and ADO index was 0.976 (P < 0.001). Only 5.7% of patients reported no limitation of their daily living activities. The correlation coefficient between daily living activities and ADO index was 0.981 (P < 0.001). Only 5.5% of patients reported no limitation of social activities. The correlation coefficient between social activities and ADO index was 0.989 (P < 0.001), between the assessed anxiety score and ADO index 0.972 (P < 0.001), and between the assessed depression score and ADO index 0.989 (P < 0.001).ConclusionsCOPD severity was significantly correlated with behavior (especially regarding smoking and cooking with biofuel in confined spaces), physical strength, daily living activities, social activities, anxiety and depression. Comprehensive approaches are required for the prevention and treatment of COPD.

Interaction of Depressive and Anxiety Symptoms on the Mortality of Patients with COPD: A Preliminary Study

Abstract Background: Depressive and anxiety symptoms increase the risk of death in patients with Chronic Obstructive Pulmonary Disease (COPD), but the combined effects of the two factors are unknown. Purpose: To assess the possible interactive effects of depressive and anxiety symptoms on the death of patients with COPD. Methods: Prospective data for 7787 Chinese patients with COPD was analyzed and the deaths were recorded. Depressive and anxiety symptoms were evaluated using the Hospital Anxiety and Depression Scale. A product of depressive and anxiety symptoms was added to the logistic regression model to evaluate the multiplicative interaction, and relative excess risk of interaction (RERI), attributable proportion (AP) of interaction, and synergy index (S) were applied to evaluate the additive interaction of the two factors. Bootstrap was used to calculate 95% confidence intervals (CIs) of RERI, AP and S. RERI > 0, AP > 0, or S > 1 indicated biological interaction. Results: After 4 years’ follow-up, the cumulative mortality was 20.0%, and the percentages of deaths in patients with depressive and anxiety symptoms were 28.5% and 30.9%, respectively. When adjusting for variables such as age, sex, disease duration, marital status, income, education level, co-morbidity, smoke status, biomass smoke, 6MWD, MRC, BMI and FEV1. the RERI, AP, and S (with 95% CIs) resulted in depression and anxiety scores of 6.54 (1.23–13.79), 0.54 (0.18–0.83), and 2.64 (1.33–4.75) respectively. Conclusion: Interaction effects were found between depressive and anxiety symptoms on the death of patients with COPD. Patients with both depressive and anxiety symptoms have an increased risk of death from COPD.

Vulnerability of patients with chronic obstructive pulmonary disease according to gender in China

Background Little information is available regarding the vulnerability of patients with chronic obstructive pulmonary disease (COPD) in China. We aimed to assess this according to patient gender. Methods A cross-sectional study was conducted in the rural area of Xuzhou in China. We interviewed and administered questionnaires to 2825 male and 2825 female patients with COPD and subjected the data generated to statistical analysis. We compared differences between proportions of male and female patients using the χ2 test. Results The rate of current smoking in men was 30.1%, whereas that in women was 10.9%, and 31.5% of men had a history of using biomass fuel compared with 75.3% of women. Further, 26.0% of the male patients and 16.4% of the female patients did not take theophylline regularly when their disease was stable. During acute exacerbations, 65.8% of the male patients and 39.7% of the female patients took theophylline or similar drugs. The average potential shortening of life expectancy was 1.76 years for men and 1.18 years for women. The average indirect economic burden was 11158.4 yuan for men and 7481.2 yuan for women. The quality of life was worse in female patients than in male patients. Conclusion We found that patients with COPD were vulnerable and that factors determining vulnerability were different for men than for women. Therefore, we recommend adopting different measures for men and women when attempting to prevent, control, and treat COPD, rehabilitate these patients, and improve their quality of life.