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 Mohan; Deepa Mohan; Sanjeev Nair; Thandi Puoane; Omar Rahman; Ah Tse Lap; Yanga Wang; Li Wei; Karen Yeates; Sumathy Rangarajan; Koon Teo; Salim Yusuf

doi:10.1289/EHP3915

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 Mohan

Deepa Mohan, Sanjeev Nair, Thandi Puoane, Omar Rahman, Ah Tse Lap, Yanga Wang, Li Wei, Karen Yeates, Sumathy Rangarajan, Koon Teo, Salim Yusuf

Oregon State University
McMaster University
University of British Columbia
University of Massachusetts Amherst
University of Toronto
Dante Pazzanese Institute of Cardiology
Aga Khan University
University of Zimbabwe
University of the Philippines Manila
North-West University
Eternal Heart Care Centre and Research Institute
Post Graduate Institute of Medical Education and Research
Universidad de La Frontera
Chinese University of Hong Kong
Fundacion Oftalmologica de Santander
St John’s Research Institute
Madras Diabetes Research Foundation
Health Action by People
University of the Western Cape
Independent University, Bangladesh
Queen's University
Chinese Academy of Sciences
Peking Union Medical College Hospital
Fuwai Hospital

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

155 Citations (Scopus)

32 Downloads (Pure)

Abstract

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 language	English
Article number	057003
Number of pages	10
Journal	Environmental Health Perspectives
Volume	127
Issue number	5
DOIs	https://doi.org/10.1289/EHP3915
Publication status	Published - 8 May 2019
Externally published	Yes

Bibliographical note

Open access

Funding

The main PURE study and its components are funded by the Population Health Research Institute, the Canadian Institutes of Health Research, and the Heart and Stroke Foundation of Ontario and through unrestricted grants from several pharmaceutical companies [with major contributions from AstraZeneca (Canada), Sanofi-Aventis (France and Canada), Boehringer Ingelheim (Germany and Canada), Servier, and GlaxoSmithKline] and additional contributions from Novartis and King Pharma. The PURE-AIR study is funded by Canadian Institutes for Health Research (CIHR; grant 136893) and by the Office of the Director, National Institutes of Health (NIH; award DP5OD019850). The content is solely the responsibility of the authors and does not necessarily represent the official views of the CIHR or the NIH. Various national or local organizations in participating countries also contributed: Funda-cion ECLA (Argentina); Independent University, Bangladesh and Mitra and Associates (Bangladesh); Unilever Health Institute (Brazil); Public Health Agency of Canada and Champlain Cardiovascular Disease Prevention Network, Canadian Institutes of Health Research, Heart and Stroke Foundation of Canada, and Population Health Research Institute (Canada); Universidad de la Frontera (Chile); National Center for Cardiovascular Diseases (China); Colciencias (grant 6566-04-18062; Colombia); Indian Council of Medical Research (India); Ministry of Science, Technology and Innovation of Malaysia [grant 100–IRDC/BIOTEK 16/ 6/21 (13/2007) and grant 07-05-IFN-BPH 010], Ministry of Higher Education of Malaysia [grant 600-RMI/LRGS/5/3 (2/2011)], Universiti Teknologi MARA, and Universiti Kebangsaan Malaysia (UKM-Hejim-Komuniti-15-2010) (Malaysia); Polish Ministry of Science and Higher Education (grant 290/W-PURE/2008/0), and Wroclaw Medical University (Poland); North-West University, South Africa and Netherlands Programme on Alternatives in Development (SANPAD), National Research Foundation, Medical Research Council of South Africa, South African Sugar Association (SASA), and Faculty of Community and Health Sciences (UWC; South Africa); AFA Insurance; Swedish Council for Working Life and Social Research, Swedish Research Council for Environment, Agricultural Sciences and Spatial Planning, Swedish Heart and Lung Foundation, Swedish Research Council, the Swedish State under LäkarUtbildningsAvtalet agreement, and the Västra Götaland Region (FOUU; Sweden); Metabolic Syndrome Society, Astra-Zeneca, and Sanofi-Aventis (Turkey); and Sheikh Hamdan Bin Rashid Al Maktoum award for Medical Sciences and Dubai Health Authority (United Arab Emirates). S.Y. holds the Heart and Stroke Foundation/Marion W. Burke Chair in Cardiovascular Disease. A complete list of PURE Project office staff, national coordinators, investigators, and key staff is provided in the section, “PURE Project Investigators and Staff,” in the Supplemental Material.

UN SDGs

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

SDG 3 Good Health and Well-being
SDG 11 Sustainable Cities and Communities

ASJC Scopus subject areas

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

Access to Document

10.1289/EHP3915

PublishedFinal published version, 1.6 MB

Cite this

Hystad, P., Duong, M., Brauer, M., Larkin, A., Arku, R., Kurmi, O. P., Qi Fan, W., Avezum, A., Azam, I., Chifamba, J., Dans, A., Du Plessis, J. L., Gupta, R., Kumar, R., Lanas, F., Liu, Z., Lu, Y., Lopez-Jaramillo, P., Mony, P., ... Yusuf, S. (2019). Health effects of household solid fuel use: Findings from 11 countries within the prospective urban and rural epidemiology study. Environmental Health Perspectives, 127(5), Article 057003. https://doi.org/10.1289/EHP3915

Hystad, P, Duong, M, Brauer, M, Larkin, A, Arku, R, Kurmi, OP, Qi Fan, W, Avezum, A, Azam, I, Chifamba, J, Dans, A, Du Plessis, JL, Gupta, R, Kumar, R, Lanas, F, Liu, Z, Lu, Y, Lopez-Jaramillo, P, Mony, P, Mohan, V, Mohan, D, Nair, S, Puoane, T, Rahman, O, Tse Lap, A, Wang, Y, Wei, L, Yeates, K, Rangarajan, S, Teo, K & Yusuf, S 2019, 'Health effects of household solid fuel use: Findings from 11 countries within the prospective urban and rural epidemiology study', Environmental Health Perspectives, vol. 127, no. 5, 057003. https://doi.org/10.1289/EHP3915

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abstract = "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.",

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T1 - Health effects of household solid fuel use

T2 - Findings from 11 countries within the prospective urban and rural epidemiology study

AU - Hystad, Perry

AU - Duong, Mylinh

AU - Brauer, Michael

AU - Larkin, Andrew

AU - Arku, Raphael

AU - Kurmi, Om P.

AU - Qi Fan, Wen

AU - Avezum, Alvaro

AU - Azam, Igbal

AU - Chifamba, Jephat

AU - Dans, Antonio

AU - Du Plessis, Johan L.

AU - Gupta, Rajeev

AU - Kumar, Rajesh

AU - Lanas, Fernando

AU - Liu, Zhiguang

AU - Lu, Yin

AU - Lopez-Jaramillo, Patricio

AU - Mony, Prem

AU - Mohan, Viswanathan

AU - Mohan, Deepa

AU - Nair, Sanjeev

AU - Puoane, Thandi

AU - Rahman, Omar

AU - Tse Lap, Ah

AU - Wang, Yanga

AU - Wei, Li

AU - Yeates, Karen

AU - Rangarajan, Sumathy

AU - Teo, Koon

AU - Yusuf, Salim

N1 - Open access

PY - 2019/5/8

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N2 - 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.

AB - 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.

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DO - 10.1289/EHP3915

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C2 - 31067132

AN - SCOPUS:85065764436

SN - 0091-6765

VL - 127

JO - Environmental Health Perspectives

JF - Environmental Health Perspectives

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M1 - 057003

ER -

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

Abstract

Bibliographical note

Funding

UN SDGs

ASJC Scopus subject areas

Access to Document

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