Abstract
Background: The adverse health effects of air pollutants are widely reported, and the elderly are susceptible to toxic environments. This study aimed to evaluate the association between use of solid fuels for cooking and mortality among the elderly.Methods: A total of 5,732 and 3,869 participants from the Chinese Longitudinal Healthy Longevity Survey were enrolled in two (2014 and 2018) and three surveys (2011, 2014, and 2018) of survey. Cooking fuel was divided into clean and solid fuel. Cox proportional hazards models were used to estimate the mortality hazard ratio (HR). Subgroup analyses were performed to assess the potential interaction effect.Results: Among the participants in the 2011–2018 survey, 53% reported using solid fuel. Such group was associated with a 9% increase in mortality risk relative to clean fuel users (HR = 1.09, 95% CI = 1.01–1.18). Among participants in the 2014–2018 survey, 339 reported a switch from solid to clean fuels and they were not at increased mortality risk relative to the 488 people that reported a stable use of clean fuels (HR = 1.14, 95% CI = 0.99–1.31) although the estimated HR was similar to the one for stable solid fuel users (HR = 1.19, 95%CI = 1.04–1.36 n = 509). Interaction and stratified analyses showed that solid fuel use had an impact on mortality in participants who were non-current smokers, had low dietary diversity scores, and were living in areas with high PM2.5 concentrations (>50 μg/m3) and city population below 8 million (P for interaction < 0.05). The association was robust in the three sensitivity analyses.Conclusion: The finding showed a clear association between solid fuel use and mortality among older Chinese, and an even stronger association between risk of mortality and solid fuel use among individuals exposed to high levels of PM2.5.
Highlights
Long-term exposure to household air pollution (HAP) is a public health problem worldwide and is among the top 10 hazard factors for disease [1, 2]
Most of the participants who reported that they use solid fuel for cooking (53.5%) lived in rural areas (71 vs. 37.9%), were illiterate (63.1 vs. 51.6%), had low annual income (45.6 vs. 19.3%), currently smoking (20.3 vs. 17.8%), never drink (69.6 vs. 65.0%), had higher dietary diversity scores (32.5 vs. 18.1%), were underweight (26.7 vs. 21.6%), seldom exercised (28.5 vs. 35.2%), had no instrumental activities of daily living (IADL) and activities of daily living (ADL) disabilities, had cognitive impairment (30.7 vs. 24.0%), and had lower proportion of chronic diseases (33.08 vs. 42.59%) compared with those who used clean fuel
The full Cox regression model showed that 339 reported a switch from solid to clean fuels and they were not at increased mortality risk relative to the 488 people that reported a stable use of clean fuels (HR = 1.14, 95% CI = 0.99–1.31) the estimated hazard ratios (HRs) was similar to the one for stable solid fuel users (HR = 1.19, 95%CI = 1.04 = 1.36 n = 509) (Table 3)
Summary
Long-term exposure to household air pollution (HAP) is a public health problem worldwide and is among the top 10 hazard factors for disease [1, 2]. The association of solid fuel use and common diseases has been proved in many studies on the elderly [7,8,9]. A cohort study indicated that the use of biomass fuel is associated with higher hazard ratios (HRs) of hypertension among the elderly (aged ≥65 years) [7]. A prospective cohort showed that longterm exposure to solid fuel and smoking can each independently increase the risk of chronic liver disease (CLD) among 501,104 participants with an average age of 52.0 years [8]. This study aimed to evaluate the association between use of solid fuels for cooking and mortality among the elderly
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