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Abstract
BackgroundThe health hazards of indoor air pollution are well-established but studies of the health effects due to pollution from heating are rare. This study investigated the association of heating and disability for activities of daily living among Chinese middle-aged and elderly.MethodsWe used two consecutive surveys in a cohort of over 17,000 adults aged 45 or older, who were interviewed first in 2011–2012 and then in 2013. In these surveys, taking advantage of random survey time, we applied a random effects logit regression model that included an interaction between pollution-producing heating fuel and a dummy variable, which measured interview time based on whether or not it was heating season.ResultsExposure to pollution-producing heating fuel was associated with a 39.9% (OR 1.399; 95%CI 1.227–1.594) and 71.0% (OR 1.710; 95%CI 1.523–1.920) increase in the likelihood of disability in activities of daily living (DADL) and disability in instrumental activities of daily living (DIADL), respectively. In heating season between year 2011 and 2013, moving from clean heating energy for heating to pollution-producing fuel was linked with an increase in the likelihoods having DADL and DIADL, with the OR of 2.014 (95%CI 1.126–3.600) and 1.956 (95%CI 1.186–3.226), respectively. However, disability increases due to change from clean energy to pollution-producing heating energy did not appear in advantaged education respondents.ConclusionsWe found that exposure to heating by burning of coal, wood, or crop residue was associated with disability in performing daily living activities. Health policymakers should take indoor pollution due to heating into consideration as it is a major determinant of activities of daily living in elderly people; especially, such policy should focus on elderly people who have disadvantaged education.
Highlights
According to the World Health Organization (WHO), almost half of the world population continues to depend on polluting fuels, including biomass fuels and coal, for their energy needs [1]
These numbers could be substantially underestimated since WHO uses estimates of the populations employing solid fuels for cooking as a proxy for indoor air pollution and does not take indoor air pollution from heating into account [3, 4]
Unlike other areas relying on solid fuels, including most regions of India and sub-Saharan Africa where heating needs are rare, in China, a substantial amount of solid fuels are used for heating [6]
Summary
According to the World Health Organization (WHO), almost half of the world population continues to depend on polluting fuels, including biomass fuels (wood, dung, and agricultural residues) and coal, for their energy needs [1]. WHO has estimated that 7.7% of global mortality is due to exposure to indoor air pollution from energy consumption, with 3.8 million deaths due to this cause in 2016 [2] These numbers could be substantially underestimated since WHO uses estimates of the populations employing solid fuels for cooking as a proxy for indoor air pollution and does not take indoor air pollution from heating into account [3, 4]. China is an ideal example to estimate the health effects of indoor air pollution due to heating, considering the large variability of demand for heating from the north to the south of the country and a large solid-fuel-dependent population [5]. This study investigated the association of heating and disability for activities of daily living among Chinese middle-aged and elderly
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