2019年中国学生肺活量体质量指数受地区、民族差异及多重因素影响

Influencing factors of forced vital capacity/weight index of Chinese students aged 7 to 18 in 2019

2019年中国7⁓18岁学生肺活量体质量指数的影响因素分析

Author: ZHANG Siying , ZHOU Yun, WANG Ruoqing, QIAN Rufei, TENG Yingjie,, DU Xuan, WU Xiulong

Source：Chinese Journal of Preventive Medicine

DOI：10.16506/j.1009-6639.2024.11.006

Abstract

Objective: To investigate pattern of forced vital capacity/weight index (FWI) change with age increase among Han students and 26 ethnic minority students in 31 provinces, municipalities and autonomous regions of China and its potential influencing factors.

Methods: A total of 212 632 Han Chinese students aged 7-18 and 89 763 ethnic minority students aged 7-18 were selected from Chinese National Surveys on Students’ Constitution and Health in 2019. We compared the FWI level of all provinces of China with national average level, as well as FWI level of Chinese minority students with Chinese Han students. Group-based trajectory model was used to identify FWI trajectories and circular heat map of FWI of Chinese Han and minorities students were drawn. Moreover, generalized additive model was used to further explore the relationship between influencing factors and FWI. Height, per capita gross domestic product, urbanization rate, and PM_2.5 were taken as smoothing terms and independent variables, with adjustment for region, gender, and age.

Results: In 2019, the FWI level of Han students aged 7 to 18 increased with age, and the FWI values for Han and minority ethnic boys [(60.67±12.98) ml/kg, (58.10±12.91) ml/kg] were higher than girls[(49.22±11.34) ml/kg, (49. 22±11. 34) ml/kg]. FWI of Han nationality students in 30 provinces (municipalities, autonomous regions of China) showed four types of FWI variation patterns: significantly higher than the national average group (by 4.17 ml/kg), slightly higher than the national average group (by 1.00 ml/kg), slightly lower than the national average group (by 2.38 ml/kg), and significantly lower than the national average (by 5.17 ml/kg). FWI of students from, economically developed areas generally had higher FWI than those from less developed northwest regions, with a maximum difference of 16.32 ml/kg. FWI trajectory of 26 minority students showed three situation patterns: slightly higher than the average level of Han nationality (by 2.75 ml/kg), slightly lower than the average level of Han nationality (by 2.82 ml/kg) and significantly lower than the average level of Han nationality (by 8.26 ml/kg). FWI for students from 19 minority ethnic groups was slightly or significantly lower than the Han average group. Height, per capita gross domestic product, urbanization rate, and PM_2.5, showed a non-linear relationship with FWI, with effective degrees of freedom (EDF) all >1 (P<0.05), and height had the greatest impact (deviance explained=9.10%).

Conclusions: There were significant regional and ethnic differences in FWI among Chinese students in 2019, which were jointly influenced by physiological,               socio-economic and environmental factors. Differentiated respiratory health promotion strategies, including air quality improvement, weight control, and physical activity, need to be developed according to socio-economic conditions in different provinces.

Keywords: Cross-sectional study; Forced vital capacity/weight index; Chinese national survey on students' constitution and health; Regional differences; Race differences

摘要:

目的：了解我国31个省（自治区、直辖市）汉族学生和26个少数民族学生肺活量体质量指数（forced vital capacity/weight index，FWI）随年龄变化模式和影响因素。

方法：选取2019年参加全国学生体质与健康调研的212 632名7~18岁汉族学生和89763名7~18岁少数民族学生作为研究对象。使用群组轨迹模型对汉族和少数民族学生FWI轨迹进行分组，绘制不同省份汉族学生和不同民族学生年龄别FWI的环状热图。采用广义加性模型分析FWI的影响因素，将身高、人均地区生产总值（gross domestic product，GDP）、城镇化率和PM_2.5，作为平滑项和自变量，调整地区、性别和年龄。

结果：2019年7~18岁汉族学生FWI水平随着年龄的增长而增加汉族和少数民族男生FWI [（60.67±12.98）、（58.10±12.91）ml/kg] 均高于女生 [（49.22±11.34）、（49.22±11.34）ml/kg]。中国30个省（自治区、直辖市）汉族学生FWI呈现4种变化模式：明显高于全国平均水平组（高4.17 ml/kg），略高于全国平均水平组（高1.00ml/kg），略低于全国平均水平组（低2.38 ml/kg）显著低于全国平均水平组（低5.17ml/kg）。经济发达地区学生FWI普遍高于落后的西北地区，最高可相差16.32 ml/kg。26个少数民族学生FWI呈现3种变化模式：略高于汉族平均水平组（高2.75 ml/kg），略低于汉族平均水平组（低2.82 ml/kg），显著低于汉族平均水平组（低8.26 ml/kg）。19个少数民族学生FWI处于略低于或显著低于汉族平均水平组。身高、人均GDP、城镇化率和PM_2.5与FWI之间存在非线性关系，有效自由度（effective degrees of freedom，EDF）均>1（P<0.05），且受身高影响最大（偏差解释率＝9.10%）。

结论：2019年中国学生FWI存在明显的地区和民族差异，受生理、社会经济和环境因素共同影响。需针对不同地区的社会经济状况开展差异化的呼吸健康促进策略，包括改善空气质量、控制体质量和加强体育锻炼等。