Regional and seasonal variations in household and personal exposures to air pollution in one urban and two rural Chinese communities: A pilot study to collect time-resolved data using static and wearable devices

Chan, Ka Hung; Xia, Xi; Ho, Kin Fai; Guo, Yu; Kurmi, Om; Du, Huaidong; Bennett, Derrick; Zheng, Bin; Kan, Haidong; McDonnell, J. A. M.; Schmidt, Dan; Kerosi, Rene; Li, Liming; Lam, Hubert; Chen, Zhengming

doi:10.1016/j.envint.2020.106217

Cited by 30 publications

(30 citation statements)

References 51 publications

(46 reference statements)

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“…We found no relevant epidemiological study examining the association of solid fuel use and glaucoma, but a recent cross-sectional analysis on ambient air pollution in >111,000 UK Biobank participants reported a marginally significant 6% (95% CI 1% to 12%) higher risk of selfreported prior diagnosis of glaucoma per 1 μg/m 3 higher exposure to ambient PM 2.5 , yet found no association with intraocular pressure (IOP) measured at the baseline assessment [38]. Interestingly, we found no evidence of an elevated risk of glaucoma in solid fuel users, despite the fact that solid fuel use is associated with 10-to 100-fold higher exposure to PM 2.5 than the above study [34,39]. Notably, the aetiology of glaucoma remains poorly understood, and most established risk factors are nonmodifiable (e.g., age, history of other eye diseases, and genetic factors) [40].…”

Section: Plos Medicinecontrasting

confidence: 83%

“…cooks. Although more detailed cooking behaviour was not assessed at baseline, in a recent air pollution exposure measurement study involving 477 individuals in CKB, the mean daily cooking duration reported by male regular cooks was 0.45 h (95% CI 0.21 to 0.70, P t test < 0.001) shorter than female regular cooks [34]. Moreover, it is known that women are inherently at higher risk of cataracts [35], so it is possible that household air pollution is particularly harmful for women due to their underlying risk profile.…”

Section: Plos Medicinementioning

confidence: 99%

“…One possible explanation for such a contrast is that clean fuel adoption reduces household air pollution exposure more substantially than ventilation, and the household air pollution levels in solid fuels-using households with ventilation often remain high (mean kitchen PM 2.5 concentration approximately 380 μg/m 3 versus approximately 120 μg/m 3 for ethanol stoves from a meta-analysis) [49]. Moreover, it is possible that some solid fuel-using households with worse household air pollution are more likely to install ventilation as a low-cost mitigation strategy, as observed in a small subset of CKB participants [34]. The heterogeneous nature and unknown effectiveness of cookstove ventilation in the study population may have introduced further noise to the analysis, masking any true association.…”

Section: Plos Medicinementioning

confidence: 99%

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Long-term solid fuel use and risks of major eye diseases in China: A population-based cohort study of 486,532 adults

et al. 2021

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Background Over 3.5 billion individuals worldwide are exposed to household air pollution from solid fuel use. There is limited evidence from cohort studies on associations of solid fuel use with risks of major eye diseases, which cause substantial disease and economic burden globally. Methods and findings The China Kadoorie Biobank recruited 512,715 adults aged 30 to 79 years from 10 areas across China during 2004 to 2008. Cooking frequency and primary fuel types in the 3 most recent residences were assessed by a questionnaire. During median (IQR) 10.1 (9.2 to 11.1) years of follow-up, electronic linkages to national health insurance databases identified 4,877 incident conjunctiva disorders, 13,408 cataracts, 1,583 disorders of sclera, cornea, iris, and ciliary body (DSCIC), and 1,534 cases of glaucoma. Logistic regression yielded odds ratios (ORs) for each disease associated with long-term use of solid fuels (i.e., coal or wood) compared to clean fuels (i.e., gas or electricity) for cooking, with adjustment for age at baseline, birth cohort, sex, study area, education, occupation, alcohol intake, smoking, environmental tobacco smoke, cookstove ventilation, heating fuel exposure, body mass index, prevalent diabetes, self-reported general health, and length of recall period. After excluding participants with missing or unreliable exposure data, 486,532 participants (mean baseline age 52.0 [SD 10.7] years; 59.1% women) were analysed. Overall, 71% of participants cooked regularly throughout the recall period, of whom 48% used solid fuels consistently. Compared with clean fuel users, solid fuel users had adjusted ORs of 1.32 (1.07 to 1.37, p < 0.001) for conjunctiva disorders, 1.17 (1.08 to 1.26, p < 0.001) for cataracts, 1.35 (1.10 to 1.66, p = 0.0046) for DSCIC, and 0.95 (0.76 to 1.18, p = 0.62) for glaucoma. Switching from solid to clean fuels was associated with smaller elevated risks (over long-term clean fuel users) than nonswitching, with adjusted ORs of 1.21 (1.07 to 1.37, p < 0.001), 1.05 (0.98 to 1.12, p = 0.17), and 1.21 (0.97 to 1.50, p = 0.088) for conjunctiva disorders, cataracts, and DSCIC, respectively. The adjusted ORs for the eye diseases were broadly similar in solid fuel users regardless of ventilation status. The main limitations of this study include the lack of baseline eye disease assessment, the use of self-reported cooking frequency and fuel types for exposure assessment, the risk of bias from delayed diagnosis (particularly for cataracts), and potential residual confounding from unmeasured factors (e.g., sunlight exposure). Conclusions Among Chinese adults, long-term solid fuel use for cooking was associated with higher risks of not only conjunctiva disorders but also cataracts and other more severe eye diseases. Switching to clean fuels appeared to mitigate the risks, underscoring the global health importance of promoting universal access to clean fuels.

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Section: Plos Medicinecontrasting

confidence: 83%

Section: Plos Medicinementioning

confidence: 99%

Section: Plos Medicinementioning

confidence: 99%

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Long-term solid fuel use and risks of major eye diseases in China: A population-based cohort study of 486,532 adults

et al. 2021

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“…This might be caused by the phenomenon of fuel stacking, that is, using multiple fuel types in one household. A previous study conducted in three provinces in China showed that 38% of the rural residents used multiple fuel types for cooking, while this figure was 0% for indoor heating 33 . Therefore, there was a possibility of misclassification of indoor cooking fuel use in our study, which might play a role in the insignificant associations between indoor solid fuel use for cooking and BP/hypertension.…”

Section: Discussionmentioning

confidence: 66%

Indoor solid fuel use for heating and cooking with blood pressure and hypertension: A cross‐sectional study among middle‐aged and older adults in China

et al. 2021

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A cross‐sectional study was conducted to investigate the impact of solid fuel use for heating and cooking on blood pressure (BP) and hypertension, using data from the China Health and Retirement Longitudinal Study (CHARLS). The primary fuels used for indoor heating and cooking were collected by questionnaires, respectively. Hypertension was defined based on self‐report of physician's diagnosis, and/or measured BP, and/or anti‐hypertensive medication use. Multivariate logistic regression models were constructed to assess the associations. Among 10 450 eligible participants, 68.2% and 57.2% used indoor solid fuel for heating and cooking, respectively. Compared with none/clean fuel users, solid fuel for heating was associated with elevated BP (adjusted β: 2.02, 95% CI: 1.04–3.01 for systolic BP; adjusted β: 1.36, 95% CI: 0.78–1.94 for diastolic BP) and increased risk of hypertension (adjusted odds ratio: 1.15, 95% CI: 1.03–1.29). The impact of indoor solid fuel for heating on BP was more evident in rural and north residents, and hypertensive patients. We did not detect any significant associations between solid fuel use for cooking and BP/hypertension. Indoor solid fuel use is prevalent in China, especially in the rural areas. Its negative impact on BP suggested that modernization of household fuel use may help to reduce the burden of hypertension in China.

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“…Additionally, China's Huai River Policy (Huai River is 0 centigrade isotherm in January in China) proposed in the 1950's provides free or heavily subsidized coal for indoor heating during winter to regions north of the Huai River but not to those to the south; the rural residents usually use solid fuel for heating. This results in a large amount of particulate matter emission in northern China; it causes more death and reduces life expectancy (37,38). In the current study, PM 2.5 is the primary reason for the north-south differential in CVD mortality rate.…”

Section: Discussionmentioning

confidence: 59%

Study on Environmental and Lifestyle Factors for the North–South Differential of Cardiovascular Disease in China

Wang

Huang

Song

et al. 2021

Front. Public Health

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Human death and life span are closely related to the geographical environment and regional lifestyle. These factors considerably vary among counties and regions, leading to the geographical disparity of disease. Quantitative studies on this phenomenon are insufficient. Cerebrovascular and heart diseases are the leading causes of death. The mortality rate of cerebrovascular and heart diseases is statistically higher in northern China than in southern China; the p-value of t-test for cerebrovascular and heart diseases was 0.047 and 0.000, respectively. The population attribution fraction of 12 major risk factors for cardiovascular disease (CVD) in each province was calculated based on their exposure and relative risk. The results found that residents in northern China consume high sodium-containing food, fewer vegetables, and less sea food products, and tend to be overweight. Fine particulate matter is higher in northern China than in southern China. Cold temperatures also cause a greater number of deaths than hot temperatures. All these factors have resulted in a higher CVD mortality rate in northern China. The attributive differential for sodium, vegetable, fruit, smoking, PM2.5, omega-3, obesity, low temperature, and high temperature of heart disease between the two parts of China is 9.1, 0.7, −2.5, 0.1, 1.4, 1.3, 2.0, 4.7, and −2.1%, respectively. Furthermore, the attributive differential for the above factors of cerebrovascular disease between the two parts of China is 8.7, 0.0, −5.2, 0.1, 1.0, 0.0, 2.4, 4.7, and −2.1%. Diet high in sodium is the leading cause of the north–south differential in CVD, resulting in 0.71 less years of life expectancy in northern compared with that in southern China.

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Regional and seasonal variations in household and personal exposures to air pollution in one urban and two rural Chinese communities: A pilot study to collect time-resolved data using static and wearable devices

Cited by 30 publications

References 51 publications

Long-term solid fuel use and risks of major eye diseases in China: A population-based cohort study of 486,532 adults

Long-term solid fuel use and risks of major eye diseases in China: A population-based cohort study of 486,532 adults

Indoor solid fuel use for heating and cooking with blood pressure and hypertension: A cross‐sectional study among middle‐aged and older adults in China

Study on Environmental and Lifestyle Factors for the North–South Differential of Cardiovascular Disease in China

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