Solid fuels for cooking and tobacco use and risk of major chronic liver disease mortality: a prospective cohort study of 0.5 million Chinese adults

China Kadoorie Biobank (CKB) collaborative group

Research output: Contribution to journalArticle

2 Citations (Scopus)


BACKGROUND: Harmful substances in solid fuel and tobacco smoke are believed to enter the bloodstream via inhalation and to be metabolized in the liver, leading to chronic liver damage. However, little is known about the independent and joint effects of solid fuel use and smoking on risks of chronic liver disease (CLD) mortality.

METHODS: During 2004-08, ∼0.5 million adults aged 30-79 years were recruited from 10 areas across China. During a 10-year median follow-up, 2461 CLD deaths were recorded. Multivariable Cox regression yielded adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for the individual associations of self-reported long-term cooking fuel and tobacco use with major CLD death.

RESULTS: Overall, 49% reported solid fuel use and 26% smoked regularly. Long-term solid fuel use for cooking and current smoking were associated with higher risks of CLD deaths, with adjusted HRs of 1.26 (95% CI, 1.02-1.56) and 1.28 (1.13-1.44), respectively. Compared with never-smoking clean fuel users, the HRs were 1.41 (1.10-1.82) in never-smoking solid fuel users, 1.55 (1.17-2.06) in regular-smoking clean fuel users and 1.71 (1.32-2.20) in regular-smoking solid fuels users. Individuals who had switched from solid to clean fuels (1.07, 0.90-1.29; for median 14 years) and ex-regular smokers who stopped for non-medical reasons (1.16, 0.95-1.43; for median 10 years) had no evidence of excess risk of CLD deaths compared with clean fuel users and never-regular smokers, respectively.

CONCLUSIONS: Among Chinese adults, long-term solid fuel use for cooking and smoking were each independently associated with higher risks of CLD deaths. Individuals who had stopped using solid fuels or smoking had lower risks.

Original languageEnglish
Pages (from-to)45-55
Number of pages11
JournalInternational Journal of Epidemiology
Issue number1
Early online date25 Oct 2019
Publication statusPublished - 1 Feb 2020
Externally publishedYes

Bibliographical note

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits
unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.


  • Adult
  • Air Pollution, Indoor/adverse effects
  • Asian Continental Ancestry Group/statistics & numerical data
  • China/epidemiology
  • Chronic Disease
  • Coal/adverse effects
  • Cooking
  • Female
  • Humans
  • Liver Diseases/mortality
  • Male
  • Middle Aged
  • Proportional Hazards Models
  • Prospective Studies
  • Risk Factors
  • Smoking/adverse effects
  • Tobacco Use/adverse effects
  • Wood/adverse effects

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