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All-Cause Mortality Risk Associated With Solid Fuel Use Among Chinese Elderly People: A National Retrospective Longitudinal Study

ABSTRACT: Background: The adverse health effects of air pollutants are widely reported, and the elderly are susceptible to toxic environments. This study aimed to evaluate the association between use of solid fuels for cooking and mortality among the elderly. Methods: A total of 5,732 and 3,869 participants from the Chinese Longitudinal Healthy Longevity Survey were enrolled in two (2014 and 2018) and three surveys (2011, 2014, and 2018) of survey. Cooking fuel was divided into clean and solid fuel. Cox proportional hazards models were used to estimate the mortality hazard ratio (HR). Subgroup analyses were performed to assess the potential interaction effect. Results: Among the participants in the 2011–2018 survey, 53% reported using solid fuel. Such group was associated with a 9% increase in mortality risk relative to clean fuel users (HR = 1.09, 95% CI = 1.01–1.18). Among participants in the 2014–2018 survey, 339 reported a switch from solid to clean fuels and they were not at increased mortality risk relative to the 488 people that reported a stable use of clean fuels (HR = 1.14, 95% CI = 0.99–1.31) although the estimated HR was similar to the one for stable solid fuel users (HR = 1.19, 95%CI = 1.04–1.36 n = 509). Interaction and stratified analyses showed that solid fuel use had an impact on mortality in participants who were non-current smokers, had low dietary diversity scores, and were living in areas with high PM2.5 concentrations (>50 μg/m3) and city population below 8 million (P for interaction < 0.05). The association was robust in the three sensitivity analyses. Conclusion: The finding showed a clear association between solid fuel use and mortality among older Chinese, and an even stronger association between risk of mortality and solid fuel use among individuals exposed to high levels of PM2.5.

SUBMITTER: Shen S

PROVIDER: S-EPMC8551618 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:ImportanceWhen combusted indoors, solid fuels generate a large amount of pollutants such as fine particulate matter.ObjectiveTo assess the associations of solid fuel use for cooking and heating with cardiovascular and all-cause mortality.Design, setting, and participantsThis nationwide prospective cohort study recruited participants from 5 rural areas across China between June 2004 and July 2008; mortality follow-up was until January 1, 2014. A total of 271?217 adults without a self-reported history of physician-diagnosed cardiovascular disease at baseline were included, with a random subset (n?=?10?892) participating in a resurvey after a mean interval of 2.7 years.ExposuresSelf-reported primary cooking and heating fuels (solid: coal, wood, or charcoal; clean: gas, electricity, or central heating), switching of fuel type before baseline, and use of ventilated cookstoves.Main outcomes and measuresDeath from cardiovascular and all causes, collected through established death registries.ResultsAmong the 271?217 participants, the mean (SD) age was 51.0 (10.2) years, and 59% (n?=?158?914) were women. A total of 66% (n?=?179?952) of the participants reported regular cooking (at least weekly) and 60% (n?=?163?882) reported winter heating, of whom 84% (n?=?150?992) and 90% (n?=?147?272) used solid fuels, respectively. There were 15?468 deaths, including 5519 from cardiovascular causes, documented during a mean (SD) of 7.2 (1.4) years of follow-up. Use of solid fuels for cooking was associated with greater risk of cardiovascular mortality (absolute rate difference [ARD] per 100?000 person-years, 135 [95% CI, 77-193]; hazard ratio [HR], 1.20 [95% CI, 1.02-1.41]) and all-cause mortality (ARD, 338 [95% CI, 249-427]; HR, 1.11 [95% CI, 1.03-1.20]). Use of solid fuels for heating was also associated with greater risk of cardiovascular mortality (ARD, 175 [95% CI, 118-231]; HR, 1.29 [95% CI, 1.06-1.55]) and all-cause mortality (ARD, 392 [95% CI, 297-487]; HR, 1.14 [95% CI, 1.03-1.26]). Compared with persistent solid fuel users, participants who reported having previously switched from solid to clean fuels for cooking had a lower risk of cardiovascular mortality (ARD, 138 [95% CI, 71-205]; HR, 0.83 [95% CI, 0.69-0.99]) and all-cause mortality (ARD, 407 [95% CI, 317-497]; HR, 0.87 [95% CI, 0.79-0.95]), while for heating, the ARDs were 193 (95% CI, 128-258) and 492 (95% CI, 383-601), and the HRs were 0.57 (95% CI, 0.42-0.77) and 0.67 (95% CI, 0.57-0.79), respectively. Among solid fuel users, use of ventilated cookstoves was also associated with lower risk of cardiovascular mortality (ARD, 33 [95% CI, -9 to 75]; HR, 0.89 [95% CI, 0.80-0.99]) and all-cause mortality (ARD, 87 [95% CI, 20-153]; HR, 0.91 [95% CI, 0.85-0.96]).Conclusions and relevanceIn rural China, solid fuel use for cooking and heating was associated with higher risks of cardiovascular and all-cause mortality. These risks may be lower among those who had previously switched to clean fuels and those who used ventilation.

Project description:BACKGROUND:Risk factors for cause-specific mortality have not been widely studied among people with HIV infection. Our objectives were to estimate rates of and risk factors for all-cause and cause-specific mortality from 1995 to 2014 among HIV-infected people in Ontario. METHODS:We conducted a population-based retrospective cohort study using provincial health databases of people with HIV infection who were aged 16 years or more, were residents of Ontario between 1995 and 2014, and had HIV infection according to a previously validated algorithm. We used International Classification of Diseases codes to classify the underlying cause of death and estimated age-adjusted mortality rates per 100 person-years for 1995 to 2014. We used descriptive statistics to characterize the cohort at baseline and calculated adjusted mortality rate ratios (RRs) using generalized estimating equations. RESULTS:Among 23 043 people, the all-cause mortality rate declined from 6.69 to 1.53 per 100 person-years over the study period, and the rate of death from HIV/AIDS declined from 4.75 to 0.46 per 100 person-years. Concomitantly, the proportions of deaths due to cancer, cardiovascular disease and other noncommunicable diseases rose; however, rates remained constant or declined. Compared to males, females had higher mortality due to cardiovascular disease (adjusted RR 1.36, 95% confidence interval [CI] 1.04-1.77), noncommunicable causes (adjusted RR 1.75, 95% CI 1.39-2.20) and, by 2010-2014, any cause (adjusted RR 1.19, 95% CI 1.02-1.38). Residing in a low-income neighbourhood was associated with increased risk for most causes, including HIV/AIDS (adjusted RR in 2010-2014 1.86, 95% CI 1.49-2.31). Rural residence was associated with increased mortality due to malignant disease (adjusted RR 1.60, 95% CI 1.10-2.34) and noncommunicable disease (adjusted RR 1.86, 95% CI 1.25-2.77). Being an immigrant was associated with lower risk of death from all causes. INTERPRETATION:Over the study period, death was increasingly due to common chronic conditions rather than to HIV infection itself. Care should incorporate the prevention and management of these conditions, especially among females and those residing in rural and low-income areas.

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All-Cause Mortality Risk Associated With Solid Fuel Use Among Chinese Elderly People: A National Retrospective Longitudinal Study

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