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; diet; lifestyle; physical activity; smoking cessation.

Figure 1

Family income and healthy lifestyle behaviors of participants with COPD in China. Notes: Smoking cessation (A), regular exercise (B), healthy diet (C), and any two or more healthy lifestyle behaviors (D). Results are adjusted for age, sex, education level, and urban or rural location as appropriate, using generalized-estimating-equation model to control for clustering. Abbreviation: COPD, chronic obstructive pulmonary disease.

Figure 2

Number of healthy lifestyle behaviors in participants with COPD in China. Notes: The participants were stratified by urban or rural location (A), age (B), sex (C), education (D), BMI (E), and symptoms (F). Results are adjusted for age, sex, education level, and urban or rural location as appropriate, using generalized-estimating-equation model to control for clustering. *p<0.05. **p<0.001. Abbreviations: COPD, chronic obstructive pulmonary disease; BMI, body mass index.