Household Fuel Use and Cardiovascular Disease Mortality

Abstract

Background Household air pollution is the third largest risk factor for global disease burden, but direct links with cardiovascular disease mortality are limited. This study aimed to evaluate the relationship between household fuel use and cardiovascular disease mortality. Methods and Results The Golestan Cohort Study in northeastern Iran enrolled 50045 individuals aged 40 to 75 years between 2004 and 2008, and collected data on lifetime household fuel use and other baseline exposures. Participants were followed through 2012 with a 99% successful follow-up rate. Cox proportional hazards models were fitted to calculate hazard ratios (HRs) for associations between pehen (local dung), wood, kerosene/diesel, or natural gas burning for cooking and heating and all-cause and cause-specific mortality, adjusting for lifetime exposure to each of these fuels and potential confounders. 3073 participants (6%) died during follow-up, 78% of which were attributable to non-communicable diseases, including cardiovascular, oncologic and respiratory illnesses. Adjusted 10-year HRs from kerosene/diesel burning were 1.06 (95% CI 1.02-1.10), and 1.11 (1.06-1.17), respectively, for all-cause and cardiovascular mortality. Subtype-specific analyses revealed a significant increase in ischemic heart disease (10-year HR 1.14 (1.06-1.21)) and a trend toward cerebrovascular accident (10-year HR 1.08 (0.99-1.17)) mortality. Stratification by sex revealed a potential signal for increased risk for all-cause and cardiovascular disease mortality among women versus men, with similar risk for ischemic heart disease mortality. Conclusions Household exposure to high-pollution fuels was associated with increased risk for all-cause and cardiovascular disease mortality. Replicating these results worldwide would support efforts to reduce such exposures.

Quantifying the Contribution to Uncertainty in Mortality Attributed to Household, Ambient, and Joint Exposure to PM2.5From Residential Solid Fuel Use

“…In addition, we assume an equal toxicity of different chemical composition of PM 2.5 (Burnett et al, ). Further, while there is limited emerging evidence of links between measures of cardiovascular health with household air pollution (e.g., Agarwal et al, ; Mitter et al, ), direct evidence of exposure to household air pollution contributing to increased risk of mortality through cardiovascular diseases was not included in the Burnett et al () concentration‐response function (though evidence of cigarette smoking and of ambient air pollution contributing to this health outcome was included). The sensitivity analysis presented here describes the apportioned uncertainty in mortality from input parameters with quantified uncertainty ranges, and thus, additional uncertainty in mortality should be considered from the major assumptions of the concentration‐response function in addition to what is considered here.…”

Polyaromatic hydrocarbons in pollution: a heart‐breaking matter

“…heating, cooking, smoking, moulds, pet dander, mosquito coils, chemical aerosols, cleaning products, ingress of outdoor air pollution, and many others), with marked differences between developed and developing nations. Similar to outdoor/ambient pollution, PM is the pollutant of concern, showing strong associations with CVDs (Mitter et al 2016). With people spending more than 80% of their time indoors, and with the ready use of unclean/inappropriate fuel sources in developing nations, the true scale of indoor air pollution is likely to come to prominence in the next decade as research in this area grows.…”

“…Similar to outdoor/ambient pollution, PM is the pollutant of concern, showing strong associations with CVDs (Mitter et al . ). With people spending more than 80% of their time indoors, and with the ready use of unclean/inappropriate fuel sources in developing nations, the true scale of indoor air pollution is likely to come to prominence in the next decade as research in this area grows.…”

Environmental Exposures and Cardiovascular Disease

“…In a study of participants living in the Brazilian Amazon, elderly individuals with increased exposure to biomass fuel smoke had increased cardiovascular mortality when compared to age-matched controls 110 . However, large cohorts in Iran and Bangladesh have failed to demonstrate an association between chronic biomass fuel use and cardiovascular mortality 111,112 . Additional studies that prospectively study cardiovascular outcomes in biomass fuel users compared to nonusers are needed to better quantify the impact of household air pollution on cardiovascular disease.…”