Solid fuel use and risks of respiratory diseases: A cohort study of 280,000 Chinese never-smokers

China Kadoorie Biobank (CKB) collaborative group

doi:10.1164/rccm.201803-0432OC

Solid fuel use and risks of respiratory diseases: A cohort study of 280,000 Chinese never-smokers

China Kadoorie Biobank (CKB) collaborative group

University of Oxford
China Kadoorie Biobank (CKB)
Oxford University Hospitals NHS Foundation Trust
Pengzhou Center for Disease Control and Prevention
Pengzhou People's Hospital
Suzhou Center for Disease Control and Prevention
Fudan University
Heilongjiang Provincial CDC
Zhejiang Provincial CDC
Chinese Academy of Sciences
Peking Union Medical College Hospital

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

87 Citations (Scopus)

42 Downloads (Pure)

Abstract

Rationale: Little evidence from large-scale cohort studies exists about the relationship of solid fuel use with hospitalization and mortality from major respiratory diseases. Objectives: To examine the associations of solid fuel use and risks of acute and chronic respiratory diseases. Methods: A cohort study of 277,838 Chinese never-smokers with no prior major chronic diseases at baseline. During 9 years of follow-up, 19,823 first hospitalization episodes or deaths from major respiratory diseases, including 10,553 chronic lower respiratory disease (CLRD), 4,398 chronic obstructive pulmonary disease (COPD), and 7,324 acute lower respiratory infection (ALRI), were recorded. Cox regression yielded adjusted hazard ratios (HRs) for disease risks associated with self-reported primary cooking fuel use. Measurements and Main Results: Overall, 91% of participants reported regular cooking, with 52% using solid fuels. Compared with clean fuel users, solid fuel users had an adjusted HR of 1.36 (95% confidence interval, 1.32-1.40) for major respiratory diseases, whereas those who switched from solid to clean fuels had a weaker HR (1.14, 1.10-1.17). The HRs were higher in wood (1.37, 1.33-1.41) than coal users (1.22, 1.15-1.29) and in those with prolonged use (>40 yr, 1.54, 1.48-1.60; ,20 yr, 1.32, 1.26-1.39), but lower among those who used ventilated than nonventilated cookstoves (1.22, 1.19-1.25 vs. 1.29, 1.24-1.35). For CLRD, COPD, and ALRI, the HRs associated with solid fuel use were 1.47 (1.41-1.52), 1.10 (1.03-1.18), and 1.16 (1.09-1.23), respectively. Conclusions: Among Chinese adults, solid fuel use for cooking was associated with higher risks of major respiratory disease admissions and death, and switching to clean fuels or use of ventilated cookstoves had lower risk than not switching.

Original language	English
Pages (from-to)	352-361
Number of pages	10
Journal	American Journal of Respiratory and Critical Care Medicine
Volume	199
Issue number	3
DOIs	https://doi.org/10.1164/rccm.201803-0432OC
Publication status	Published - 1 Feb 2019
Externally published	Yes

Bibliographical note

This article is open access and distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/).

Funding

*Senior author. A list of members of the China Kadoorie Biobank Collaborative Group may be found before the beginning of the REFERENCES. Supported by the UK Medical Research Council: Global Challenges Research Fund (Foundation Award MR/P025080/1). K.H.C. is a recipient of the D.Phil. Scholarship from the Nuffield Department of Population Health and St. Anne’s College, University of Oxford. The CKB baseline survey and the first resurvey were supported by the Kadoorie Charitable Foundation in Hong Kong. Long-term follow-up has been supported by the UK Wellcome Trust (202922/Z/16/Z, 104085/Z/14/Z, and 088158/Z/09/Z) and grants from the National Natural Science Foundation of China (81390540, 81390541, and 81390544) and from the National Key Research and Development Program of China (2016YFC0900500, 2016YFC0900501, 2016YFC0900504, and 2016YFC1303904). 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.

UN SDGs

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

SDG 3 Good Health and Well-being
SDG 7 Affordable and Clean Energy

Keywords

Acute lower respiratory infection
Chronic obstructive pulmonary disease
Household air pollution
Solid fuels

ASJC Scopus subject areas

Pulmonary and Respiratory Medicine
Critical Care and Intensive Care Medicine

Access to Document

10.1164/rccm.201803-0432OCLicence: CC BY

rccm.201803-0432ocFinal published version, 839 KBLicence: CC BY

Cite this

@article{8f576cbde13e4daea894693b368278a8,

title = "Solid fuel use and risks of respiratory diseases: A cohort study of 280,000 Chinese never-smokers",

abstract = "Rationale: Little evidence from large-scale cohort studies exists about the relationship of solid fuel use with hospitalization and mortality from major respiratory diseases. Objectives: To examine the associations of solid fuel use and risks of acute and chronic respiratory diseases. Methods: A cohort study of 277,838 Chinese never-smokers with no prior major chronic diseases at baseline. During 9 years of follow-up, 19,823 first hospitalization episodes or deaths from major respiratory diseases, including 10,553 chronic lower respiratory disease (CLRD), 4,398 chronic obstructive pulmonary disease (COPD), and 7,324 acute lower respiratory infection (ALRI), were recorded. Cox regression yielded adjusted hazard ratios (HRs) for disease risks associated with self-reported primary cooking fuel use. Measurements and Main Results: Overall, 91\% of participants reported regular cooking, with 52\% using solid fuels. Compared with clean fuel users, solid fuel users had an adjusted HR of 1.36 (95\% confidence interval, 1.32-1.40) for major respiratory diseases, whereas those who switched from solid to clean fuels had a weaker HR (1.14, 1.10-1.17). The HRs were higher in wood (1.37, 1.33-1.41) than coal users (1.22, 1.15-1.29) and in those with prolonged use (>40 yr, 1.54, 1.48-1.60; ,20 yr, 1.32, 1.26-1.39), but lower among those who used ventilated than nonventilated cookstoves (1.22, 1.19-1.25 vs. 1.29, 1.24-1.35). For CLRD, COPD, and ALRI, the HRs associated with solid fuel use were 1.47 (1.41-1.52), 1.10 (1.03-1.18), and 1.16 (1.09-1.23), respectively. Conclusions: Among Chinese adults, solid fuel use for cooking was associated with higher risks of major respiratory disease admissions and death, and switching to clean fuels or use of ventilated cookstoves had lower risk than not switching.",

keywords = "Acute lower respiratory infection, Chronic obstructive pulmonary disease, Household air pollution, Solid fuels",

author = "\{China Kadoorie Biobank (CKB) collaborative group\} and Chan, \{Ka Hung\} and Kurmi, \{Om P.\} and Bennett, \{Derrick A.\} and Ling Yang and Yiping Chen and Yunlong Tan and Pei Pei and Xunfu Zhong and Jianxin Chen and Jun Zhang and Haidong Kan and Richard Peto and Lam, \{Kin Bong Hubert\} and Zhengming Chen and Junshi Chen and Robert Clarke and Rory Collins and Yu Guo and Liming Li and Jun Lv and Robin Walters and Daniel Avery and Ruth Boxall and Yumei Chang and Huaidong Du and Simon Gilbert and Alex Hacker and Michael Holmes and Christiana Kartsonaki and Rene Kerosi and Garry Lancaster and Kuang Lin and John McDonnell and Iona Millwood and Qunhua Nie and Jayakrishnan Radhakrishnan and Paul Ryder and Sam Sansome and Dan Schmidt and Rajani Sohoni and Becky Stevens and Iain Turnbull and Jenny Wang and Lin Wang and Neil Wright and Xiaoming Yang and Zheng Bian and Xiao Han and Xue Zhou and Hao Wang",

note = "This article is open access and distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/).",

year = "2019",

month = feb,

day = "1",

doi = "10.1164/rccm.201803-0432OC",

language = "English",

volume = "199",

pages = "352--361",

journal = "American Journal of Respiratory and Critical Care Medicine",

issn = "1073-449X",

publisher = "Oxford University Press",

number = "3",

}

TY - JOUR

T1 - Solid fuel use and risks of respiratory diseases

T2 - A cohort study of 280,000 Chinese never-smokers

AU - China Kadoorie Biobank (CKB) collaborative group

AU - Chan, Ka Hung

AU - Kurmi, Om P.

AU - Bennett, Derrick A.

AU - Yang, Ling

AU - Chen, Yiping

AU - Tan, Yunlong

AU - Pei, Pei

AU - Zhong, Xunfu

AU - Chen, Jianxin

AU - Zhang, Jun

AU - Kan, Haidong

AU - Peto, Richard

AU - Lam, Kin Bong Hubert

AU - Chen, Zhengming

AU - Chen, Junshi

AU - Clarke, Robert

AU - Collins, Rory

AU - Guo, Yu

AU - Li, Liming

AU - Lv, Jun

AU - Walters, Robin

AU - Avery, Daniel

AU - Boxall, Ruth

AU - Chang, Yumei

AU - Du, Huaidong

AU - Gilbert, Simon

AU - Hacker, Alex

AU - Holmes, Michael

AU - Kartsonaki, Christiana

AU - Kerosi, Rene

AU - Lancaster, Garry

AU - Lin, Kuang

AU - McDonnell, John

AU - Millwood, Iona

AU - Nie, Qunhua

AU - Radhakrishnan, Jayakrishnan

AU - Ryder, Paul

AU - Sansome, Sam

AU - Schmidt, Dan

AU - Sohoni, Rajani

AU - Stevens, Becky

AU - Turnbull, Iain

AU - Wang, Jenny

AU - Wang, Lin

AU - Wright, Neil

AU - Yang, Xiaoming

AU - Bian, Zheng

AU - Han, Xiao

AU - Zhou, Xue

AU - Wang, Hao

N1 - This article is open access and distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/).

PY - 2019/2/1

Y1 - 2019/2/1

N2 - Rationale: Little evidence from large-scale cohort studies exists about the relationship of solid fuel use with hospitalization and mortality from major respiratory diseases. Objectives: To examine the associations of solid fuel use and risks of acute and chronic respiratory diseases. Methods: A cohort study of 277,838 Chinese never-smokers with no prior major chronic diseases at baseline. During 9 years of follow-up, 19,823 first hospitalization episodes or deaths from major respiratory diseases, including 10,553 chronic lower respiratory disease (CLRD), 4,398 chronic obstructive pulmonary disease (COPD), and 7,324 acute lower respiratory infection (ALRI), were recorded. Cox regression yielded adjusted hazard ratios (HRs) for disease risks associated with self-reported primary cooking fuel use. Measurements and Main Results: Overall, 91% of participants reported regular cooking, with 52% using solid fuels. Compared with clean fuel users, solid fuel users had an adjusted HR of 1.36 (95% confidence interval, 1.32-1.40) for major respiratory diseases, whereas those who switched from solid to clean fuels had a weaker HR (1.14, 1.10-1.17). The HRs were higher in wood (1.37, 1.33-1.41) than coal users (1.22, 1.15-1.29) and in those with prolonged use (>40 yr, 1.54, 1.48-1.60; ,20 yr, 1.32, 1.26-1.39), but lower among those who used ventilated than nonventilated cookstoves (1.22, 1.19-1.25 vs. 1.29, 1.24-1.35). For CLRD, COPD, and ALRI, the HRs associated with solid fuel use were 1.47 (1.41-1.52), 1.10 (1.03-1.18), and 1.16 (1.09-1.23), respectively. Conclusions: Among Chinese adults, solid fuel use for cooking was associated with higher risks of major respiratory disease admissions and death, and switching to clean fuels or use of ventilated cookstoves had lower risk than not switching.

AB - Rationale: Little evidence from large-scale cohort studies exists about the relationship of solid fuel use with hospitalization and mortality from major respiratory diseases. Objectives: To examine the associations of solid fuel use and risks of acute and chronic respiratory diseases. Methods: A cohort study of 277,838 Chinese never-smokers with no prior major chronic diseases at baseline. During 9 years of follow-up, 19,823 first hospitalization episodes or deaths from major respiratory diseases, including 10,553 chronic lower respiratory disease (CLRD), 4,398 chronic obstructive pulmonary disease (COPD), and 7,324 acute lower respiratory infection (ALRI), were recorded. Cox regression yielded adjusted hazard ratios (HRs) for disease risks associated with self-reported primary cooking fuel use. Measurements and Main Results: Overall, 91% of participants reported regular cooking, with 52% using solid fuels. Compared with clean fuel users, solid fuel users had an adjusted HR of 1.36 (95% confidence interval, 1.32-1.40) for major respiratory diseases, whereas those who switched from solid to clean fuels had a weaker HR (1.14, 1.10-1.17). The HRs were higher in wood (1.37, 1.33-1.41) than coal users (1.22, 1.15-1.29) and in those with prolonged use (>40 yr, 1.54, 1.48-1.60; ,20 yr, 1.32, 1.26-1.39), but lower among those who used ventilated than nonventilated cookstoves (1.22, 1.19-1.25 vs. 1.29, 1.24-1.35). For CLRD, COPD, and ALRI, the HRs associated with solid fuel use were 1.47 (1.41-1.52), 1.10 (1.03-1.18), and 1.16 (1.09-1.23), respectively. Conclusions: Among Chinese adults, solid fuel use for cooking was associated with higher risks of major respiratory disease admissions and death, and switching to clean fuels or use of ventilated cookstoves had lower risk than not switching.

KW - Acute lower respiratory infection

KW - Chronic obstructive pulmonary disease

KW - Household air pollution

KW - Solid fuels

UR - https://www.scopus.com/pages/publications/85060908295

U2 - 10.1164/rccm.201803-0432OC

DO - 10.1164/rccm.201803-0432OC

M3 - Article

C2 - 30235936

AN - SCOPUS:85060908295

SN - 1073-449X

VL - 199

SP - 352

EP - 361

JO - American Journal of Respiratory and Critical Care Medicine

JF - American Journal of Respiratory and Critical Care Medicine

IS - 3

ER -

Solid fuel use and risks of respiratory diseases: A cohort study of 280,000 Chinese never-smokers

Abstract

Bibliographical note

Funding

UN SDGs

Keywords

ASJC Scopus subject areas

Access to Document

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