Health effects of household solid fuel use: Findings from 11 countries within the prospective urban and rural epidemiology study

Perry Hystad, Mylinh Duong, Michael Brauer, Andrew Larkin, Raphael Arku, Om P. Kurmi, Wen Qi Fan, Alvaro Avezum, Igbal Azam, Jephat Chifamba, Antonio Dans, Johan L. Du Plessis, Rajeev Gupta, Rajesh Kumar, Fernando Lanas, Zhiguang Liu, Yin Lu, Patricio Lopez-Jaramillo, Prem Mony, Viswanathan MohanDeepa Mohan, Sanjeev Nair, Thandi Puoane, Omar Rahman, Ah Tse Lap, Yanga Wang, Li Wei, Karen Yeates, Sumathy Rangarajan, Koon Teo, Salim Yusuf

Research output: Contribution to journalArticlepeer-review

75 Citations (Scopus)
10 Downloads (Pure)


Background: Household air pollution (HAP) from solid fuel use for cooking affects 2.5 billion individuals globally and may contribute substantially to disease burden. However, few prospective studies have assessed the impact of HAP on mortality and cardiorespiratory disease. Objectives: Our goal was to evaluate associations between HAP and mortality, cardiovascular disease (CVD), and respiratory disease in the prospective urban and rural epidemiology (PURE) study. Methods: We studied 91,350 adults 35–70 y of age from 467 urban and rural communities in 11 countries (Bangladesh, Brazil, Chile, China, Colombia, India, Pakistan, Philippines, South Africa, Tanzania, and Zimbabwe). After a median follow-up period of 9.1 y, we recorded 6,595 deaths, 5,472 incident cases of CVD (CVD death or nonfatal myocardial infarction, stroke, or heart failure), and 2,436 incident cases of respiratory disease (respiratory death or nonfatal chronic obstructive pulmonary disease, pulmonary tuberculosis, pneumonia, or lung cancer). We used Cox proportional hazards models adjusted for individual, household, and community-level characteristics to compare events for individuals living in households that used solid fuels for cooking to those using electricity or gas. Results:We found that 41.8% of participants lived in households using solid fuels as their primary cooking fuel. Compared with electricity or gas, solid fuel use was associated with fully adjusted hazard ratios of 1.12 (95% CI: 1.04, 1.21) for all-cause mortality, 1.08 (95% CI: 0.99, 1.17) for fatal or nonfatal CVD, 1.14 (95% CI: 1.00, 1.30) for fatal or nonfatal respiratory disease, and 1.12 (95% CI: 1.06, 1.19) for mortality from any cause or the first incidence of a nonfatal cardiorespiratory outcome. Associations persisted in extensive sensitivity analyses, but small differences were observed across study regions and across individual and household characteristics. Discussion: Use of solid fuels for cooking is a risk factor for mortality and cardiorespiratory disease. Continued efforts to replace solid fuels with cleaner alternatives are needed to reduce premature mortality and morbidity in developing countries.

Original languageEnglish
Article number057003
Number of pages10
JournalEnvironmental Health Perspectives
Issue number5
Publication statusPublished - 8 May 2019
Externally publishedYes

Bibliographical note

Open access

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Health, Toxicology and Mutagenesis


Dive into the research topics of 'Health effects of household solid fuel use: Findings from 11 countries within the prospective urban and rural epidemiology study'. Together they form a unique fingerprint.

Cite this