Cooking fuels and risk of all-cause and cardiopulmonary mortality in urban China: a prospective cohort study

China Kadoorie Biobank (CKB) collaborative group; Kuai Yu; Jun Lv; Gaokun Qiu; Canqing Yu; Yu Guo; Zheng Bian; Ling Yang; Yiping Chen; Chaolong Wang; An Pan; Liming Liang; Frank B Hu; Zhengming Chen; Liming Li; Tangchun Wu

doi:10.1016/S2214-109X(19)30525-X

Cooking fuels and risk of all-cause and cardiopulmonary mortality in urban China: a prospective cohort study

China Kadoorie Biobank (CKB) collaborative group, Kuai Yu, Jun Lv, Gaokun Qiu, Canqing Yu, Yu Guo, Zheng Bian, Ling Yang, Yiping Chen, Chaolong Wang, An Pan, Liming Liang, Frank B Hu, Zhengming Chen, Liming Li, Tangchun Wu

Research Centre for Intelligent Healthcare

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Abstract

BACKGROUND: Cooking practice has transitioned from use of solid fuels to use of clean fuels, with addition of better ventilation facilities. However, the change in mortality risk associated with such a transition remains unclear.

METHODS: The China Kadoorie Biobank (CKB) Study enrolled participants (aged 30-79 years) from ten areas across China; we chose to study participants from five urban areas where transition from use of solid fuels to clean fuels for cooking was prevalent. Participants who reported regular cooking (weekly or more frequently) at baseline were categorised as persistent clean fuel users, previous solid fuel users, or persistent solid fuel users, according to self-reported fuel use histories. All-cause and cardiopulmonary mortality were identified through linkage to China's Disease Surveillance Point system and local mortality records.

FINDINGS: Between June 24, 2004, and July 15, 2008, 226 186 participants living in five urban areas of China were enrolled in the CKB Study. Among 171 677 participants who reported cooking regularly (weekly or more frequently), 75 785 (44%) were persistent clean fuel users, 80 511 (47%) were previous solid fuel users, and 15 381 (9%) were persistent solid fuel users. During a mean of 9·8 (SD 1·7) years of follow-up, 10 831 deaths were documented, including 3819 cardiovascular deaths and 761 respiratory deaths. Compared with persistent clean fuel users, persistent solid fuel users had significantly higher risks of all-cause mortality (hazard ratio [HR] 1·19, 95% CI 1·10-1·28), cardiovascular mortality (1·24, 1·10-1·39), and respiratory mortality (1·43, 1·10-1·85). The excess risk of all-cause and cardiopulmonary mortality fell by more than 60% in 5 years after cessation of solid fuel use and continued to decrease afterwards. Use of ventilation was associated with lower all-cause mortality risk, even among persistent clean fuel users (HR 0·78, 0·69-0·89).

INTERPRETATION: Solid fuel use for cooking is associated with a higher risk of mortality, and cessation of solid fuel use cuts excess mortality risks swiftly and substantially within 5 years. Ventilation use also lowers the risk of mortality, even among people who persistently use clean fuels. It is of prime importance for both policy makers and the public to accelerate the transition from solid fuels to clean fuels and promote efficient ventilation to minimise further adverse health effects.

FUNDING: National Natural Science Foundation of China, Wellcome Trust, and Kadoorie Charitable Foundation.

Original language	English
Pages (from-to)	e430-e439
Number of pages	10
Journal	The Lancet Global Health
Volume	8
Issue number	3
Early online date	19 Jan 2020
DOIs	https://doi.org/10.1016/S2214-109X(19)30525-X
Publication status	Published - Mar 2020

Bibliographical note

This is an Open Access article under the CC BY 4.0 license.

Funder

This work was supported by grants from the National Natural Science Foundation of China ( 91843302 , 91643202 , and 81390540 ), the Foundation of National Key Program of Research and Development of China ( 2016YFC0900800 ), the 111 Project and the Program for Changjiang Scholars, Innovative Research Team in University, and the Fundamental Research Funds for the Central Universities ( 2019kfyXMBZ015 ). The China Kadoorie Biobank baseline survey and the first resurvey were supported by the Kadoorie Charitable Foundation in Hong Kong. Long-term follow-up is supported by the UK Wellcome Trust ( 088158/Z/09/Z and 104085/Z/14/Z ), the National Key Research and Development Program of China ( 2016YFC0900500 , 2016YFC0900501 , and 2016YFC0900504 ), and the Chinese Ministry of Science and Technology ( 2011BAI09B01 ). The British Heart Foundation, UK Medical Research Council, and Cancer Research provide core funding to the Clinical Trial Service Unit and Epidemiological Studies Unit at Oxford University for the project.

Keywords

Adult
Aged
Cardiovascular Diseases/mortality
Cause of Death
China/epidemiology
Cooking/methods
Electricity
Female
Fossil Fuels
Humans
Lung Diseases/mortality
Male
Middle Aged
Prospective Studies
Risk
Urban Population/statistics & numerical data
Wood

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Cite this

China Kadoorie Biobank (CKB) collaborative group, Yu, K., Lv, J., Qiu, G., Yu, C., Guo, Y., Bian, Z., Yang, L., Chen, Y., Wang, C., Pan, A., Liang, L., Hu, F. B., Chen, Z., Li, L., & Wu, T. (2020). Cooking fuels and risk of all-cause and cardiopulmonary mortality in urban China: a prospective cohort study. The Lancet Global Health, 8(3), e430-e439. https://doi.org/10.1016/S2214-109X(19)30525-X

Cooking fuels and risk of all-cause and cardiopulmonary mortality in urban China : a prospective cohort study. / China Kadoorie Biobank (CKB) collaborative group; Yu, Kuai; Lv, Jun; Qiu, Gaokun; Yu, Canqing; Guo, Yu; Bian, Zheng; Yang, Ling; Chen, Yiping; Wang, Chaolong; Pan, An; Liang, Liming; Hu, Frank B; Chen, Zhengming; Li, Liming; Wu, Tangchun.

In: The Lancet Global Health, Vol. 8, No. 3, 03.2020, p. e430-e439.

Research output: Contribution to journal › Article › peer-review

China Kadoorie Biobank (CKB) collaborative group, Yu, K, Lv, J, Qiu, G, Yu, C, Guo, Y, Bian, Z, Yang, L, Chen, Y, Wang, C, Pan, A, Liang, L, Hu, FB, Chen, Z, Li, L & Wu, T 2020, 'Cooking fuels and risk of all-cause and cardiopulmonary mortality in urban China: a prospective cohort study', The Lancet Global Health, vol. 8, no. 3, pp. e430-e439. https://doi.org/10.1016/S2214-109X(19)30525-X

China Kadoorie Biobank (CKB) collaborative group ; Yu, Kuai ; Lv, Jun ; Qiu, Gaokun ; Yu, Canqing ; Guo, Yu ; Bian, Zheng ; Yang, Ling ; Chen, Yiping ; Wang, Chaolong ; Pan, An ; Liang, Liming ; Hu, Frank B ; Chen, Zhengming ; Li, Liming ; Wu, Tangchun. / Cooking fuels and risk of all-cause and cardiopulmonary mortality in urban China : a prospective cohort study. In: The Lancet Global Health. 2020 ; Vol. 8, No. 3. pp. e430-e439.

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title = "Cooking fuels and risk of all-cause and cardiopulmonary mortality in urban China: a prospective cohort study",

abstract = "BACKGROUND: Cooking practice has transitioned from use of solid fuels to use of clean fuels, with addition of better ventilation facilities. However, the change in mortality risk associated with such a transition remains unclear.METHODS: The China Kadoorie Biobank (CKB) Study enrolled participants (aged 30-79 years) from ten areas across China; we chose to study participants from five urban areas where transition from use of solid fuels to clean fuels for cooking was prevalent. Participants who reported regular cooking (weekly or more frequently) at baseline were categorised as persistent clean fuel users, previous solid fuel users, or persistent solid fuel users, according to self-reported fuel use histories. All-cause and cardiopulmonary mortality were identified through linkage to China's Disease Surveillance Point system and local mortality records.FINDINGS: Between June 24, 2004, and July 15, 2008, 226 186 participants living in five urban areas of China were enrolled in the CKB Study. Among 171 677 participants who reported cooking regularly (weekly or more frequently), 75 785 (44%) were persistent clean fuel users, 80 511 (47%) were previous solid fuel users, and 15 381 (9%) were persistent solid fuel users. During a mean of 9·8 (SD 1·7) years of follow-up, 10 831 deaths were documented, including 3819 cardiovascular deaths and 761 respiratory deaths. Compared with persistent clean fuel users, persistent solid fuel users had significantly higher risks of all-cause mortality (hazard ratio [HR] 1·19, 95% CI 1·10-1·28), cardiovascular mortality (1·24, 1·10-1·39), and respiratory mortality (1·43, 1·10-1·85). The excess risk of all-cause and cardiopulmonary mortality fell by more than 60% in 5 years after cessation of solid fuel use and continued to decrease afterwards. Use of ventilation was associated with lower all-cause mortality risk, even among persistent clean fuel users (HR 0·78, 0·69-0·89).INTERPRETATION: Solid fuel use for cooking is associated with a higher risk of mortality, and cessation of solid fuel use cuts excess mortality risks swiftly and substantially within 5 years. Ventilation use also lowers the risk of mortality, even among people who persistently use clean fuels. It is of prime importance for both policy makers and the public to accelerate the transition from solid fuels to clean fuels and promote efficient ventilation to minimise further adverse health effects.FUNDING: National Natural Science Foundation of China, Wellcome Trust, and Kadoorie Charitable Foundation.",

keywords = "Adult, Aged, Cardiovascular Diseases/mortality, Cause of Death, China/epidemiology, Cooking/methods, Electricity, Female, Fossil Fuels, Humans, Lung Diseases/mortality, Male, Middle Aged, Prospective Studies, Risk, Urban Population/statistics & numerical data, Wood",

author = "{China Kadoorie Biobank (CKB) collaborative group} and Kuai Yu and Jun Lv and Gaokun Qiu and Canqing Yu and Yu Guo and Zheng Bian and Ling Yang and Yiping Chen and Chaolong Wang and An Pan and Liming Liang and Hu, {Frank B} and Zhengming Chen and Liming Li and Tangchun Wu and Om Kurmi",

note = " This is an Open Access article under the CC BY 4.0 license.",

year = "2020",

month = mar,

doi = "10.1016/S2214-109X(19)30525-X",

language = "English",

volume = "8",

pages = "e430--e439",

journal = "The Lancet Global Health",

issn = "2214-109X",

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TY - JOUR

T1 - Cooking fuels and risk of all-cause and cardiopulmonary mortality in urban China

T2 - a prospective cohort study

AU - China Kadoorie Biobank (CKB) collaborative group

AU - Yu, Kuai

AU - Lv, Jun

AU - Qiu, Gaokun

AU - Yu, Canqing

AU - Guo, Yu

AU - Bian, Zheng

AU - Yang, Ling

AU - Chen, Yiping

AU - Wang, Chaolong

AU - Pan, An

AU - Liang, Liming

AU - Hu, Frank B

AU - Chen, Zhengming

AU - Li, Liming

AU - Wu, Tangchun

AU - Kurmi, Om

N1 - This is an Open Access article under the CC BY 4.0 license.

PY - 2020/3

Y1 - 2020/3

N2 - BACKGROUND: Cooking practice has transitioned from use of solid fuels to use of clean fuels, with addition of better ventilation facilities. However, the change in mortality risk associated with such a transition remains unclear.METHODS: The China Kadoorie Biobank (CKB) Study enrolled participants (aged 30-79 years) from ten areas across China; we chose to study participants from five urban areas where transition from use of solid fuels to clean fuels for cooking was prevalent. Participants who reported regular cooking (weekly or more frequently) at baseline were categorised as persistent clean fuel users, previous solid fuel users, or persistent solid fuel users, according to self-reported fuel use histories. All-cause and cardiopulmonary mortality were identified through linkage to China's Disease Surveillance Point system and local mortality records.FINDINGS: Between June 24, 2004, and July 15, 2008, 226 186 participants living in five urban areas of China were enrolled in the CKB Study. Among 171 677 participants who reported cooking regularly (weekly or more frequently), 75 785 (44%) were persistent clean fuel users, 80 511 (47%) were previous solid fuel users, and 15 381 (9%) were persistent solid fuel users. During a mean of 9·8 (SD 1·7) years of follow-up, 10 831 deaths were documented, including 3819 cardiovascular deaths and 761 respiratory deaths. Compared with persistent clean fuel users, persistent solid fuel users had significantly higher risks of all-cause mortality (hazard ratio [HR] 1·19, 95% CI 1·10-1·28), cardiovascular mortality (1·24, 1·10-1·39), and respiratory mortality (1·43, 1·10-1·85). The excess risk of all-cause and cardiopulmonary mortality fell by more than 60% in 5 years after cessation of solid fuel use and continued to decrease afterwards. Use of ventilation was associated with lower all-cause mortality risk, even among persistent clean fuel users (HR 0·78, 0·69-0·89).INTERPRETATION: Solid fuel use for cooking is associated with a higher risk of mortality, and cessation of solid fuel use cuts excess mortality risks swiftly and substantially within 5 years. Ventilation use also lowers the risk of mortality, even among people who persistently use clean fuels. It is of prime importance for both policy makers and the public to accelerate the transition from solid fuels to clean fuels and promote efficient ventilation to minimise further adverse health effects.FUNDING: National Natural Science Foundation of China, Wellcome Trust, and Kadoorie Charitable Foundation.

AB - BACKGROUND: Cooking practice has transitioned from use of solid fuels to use of clean fuels, with addition of better ventilation facilities. However, the change in mortality risk associated with such a transition remains unclear.METHODS: The China Kadoorie Biobank (CKB) Study enrolled participants (aged 30-79 years) from ten areas across China; we chose to study participants from five urban areas where transition from use of solid fuels to clean fuels for cooking was prevalent. Participants who reported regular cooking (weekly or more frequently) at baseline were categorised as persistent clean fuel users, previous solid fuel users, or persistent solid fuel users, according to self-reported fuel use histories. All-cause and cardiopulmonary mortality were identified through linkage to China's Disease Surveillance Point system and local mortality records.FINDINGS: Between June 24, 2004, and July 15, 2008, 226 186 participants living in five urban areas of China were enrolled in the CKB Study. Among 171 677 participants who reported cooking regularly (weekly or more frequently), 75 785 (44%) were persistent clean fuel users, 80 511 (47%) were previous solid fuel users, and 15 381 (9%) were persistent solid fuel users. During a mean of 9·8 (SD 1·7) years of follow-up, 10 831 deaths were documented, including 3819 cardiovascular deaths and 761 respiratory deaths. Compared with persistent clean fuel users, persistent solid fuel users had significantly higher risks of all-cause mortality (hazard ratio [HR] 1·19, 95% CI 1·10-1·28), cardiovascular mortality (1·24, 1·10-1·39), and respiratory mortality (1·43, 1·10-1·85). The excess risk of all-cause and cardiopulmonary mortality fell by more than 60% in 5 years after cessation of solid fuel use and continued to decrease afterwards. Use of ventilation was associated with lower all-cause mortality risk, even among persistent clean fuel users (HR 0·78, 0·69-0·89).INTERPRETATION: Solid fuel use for cooking is associated with a higher risk of mortality, and cessation of solid fuel use cuts excess mortality risks swiftly and substantially within 5 years. Ventilation use also lowers the risk of mortality, even among people who persistently use clean fuels. It is of prime importance for both policy makers and the public to accelerate the transition from solid fuels to clean fuels and promote efficient ventilation to minimise further adverse health effects.FUNDING: National Natural Science Foundation of China, Wellcome Trust, and Kadoorie Charitable Foundation.

KW - Adult

KW - Aged

KW - Cardiovascular Diseases/mortality

KW - Cause of Death

KW - China/epidemiology

KW - Cooking/methods

KW - Electricity

KW - Female

KW - Fossil Fuels

KW - Humans

KW - Lung Diseases/mortality

KW - Male

KW - Middle Aged

KW - Prospective Studies

KW - Risk

KW - Urban Population/statistics & numerical data

KW - Wood

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DO - 10.1016/S2214-109X(19)30525-X

M3 - Article

C2 - 31972151

VL - 8

SP - e430-e439

JO - The Lancet Global Health

JF - The Lancet Global Health

SN - 2214-109X

IS - 3

ER -

Cooking fuels and risk of all-cause and cardiopulmonary mortality in urban China: a prospective cohort study

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