Indoor solid fuel use for cooking and the risk of incidental non-fatal cardiovascular disease among middle-aged and elderly Chinese adults: a prospective cohort study

Association of household solid fuel use and long-term exposure to ambient air pollution with estimated 10-year high cardiovascular disease risk among postmenopausal women

This study aimed to explore the separate and joint effects of long-term ambient air pollution and household air pollution exposure on 10-year high cardiovascular disease (CVD) risk among postmenopausal women. A total of 4679 postmenopausal women from the China Health and Retirement Longitudinal Study (CHARLS) were included in this study. Information of fuel type was collected by standard questionnaires and use of solid fuel was considered as a proxy for household air pollution. Data of ambient air pollutants (PM1, PM2.5, PM10, SO2, NO2, CO, O3) were obtained from the ChinaHighAirPollutants (CHAP) datasets. Logistic regression models were performed to assess the separate and joint effects of long-term exposure to ambient air pollution and use of solid fuel on 10-year high CVD risk. We found use of solid fuel and its duration and ambient air pollutants (PM1, PM2.5, PM10, SO2, NO2) were all positively associated with 10-year high CVD risk among postmenopausal women (P < 0.05). Compared to those used clean fuel and exposed to low ambient air pollution levels, odds ratios (ORs) and 95% confidence intervals (CIs) for participants using solid fuels and exposed to high ambient air pollution levels (PM1, PM2.5, PM10, SO2, NO2, CO, O3) were 1.66 (1.35, 2.05), 1.66 (1.35, 2.04), 1.49 (1.22, 1.83), 1.28 (1.05, 1.57), 1.67 (1.34, 2.07), 1.28 (1.04, 1.57), 1.46 (1.18, 1.80), respectively. Moreover, significant additive interactions of solid fuel use with PM1 and PM2.5 on 10-year high CVD risk were observed, with approximately 18% and 23% of 10-year high risk of CVD attributable to the interaction. Overall, indoor and outdoor air pollution had separate and joint effects on 10-year high CVD risk among postmenopausal women. Therefore, simultaneously improving indoor and outdoor air quality are of great importance and could have a joint impact on prevention of CVD and improved health among postmenopausal women.

Spatial variation and determinants of solid fuel use in Ethiopia; Mixed effect and spatial analysis using 2019 Ethiopia Mini Demographic and Health Survey dataset

BACKGROUND

According to UNSD, World Bank, and WHO, a 2020 joint report, 3 billion people who used solid fuel were found in low and middle-income countries. The burning of such type of fuel emits a variety of pollutants such as PM2.5, PM10, CO, NO2, organic compounds, and other substances which a had wide range of public health problems The evidence from the WHO report, indoor air pollution was attributed to around 3.2 million deaths each year in 2020, and more than 237 000 deaths of children under the age of five. This study aims to investigate solid fuel prevalence, predictors, and spatial variation in Ethiopia.

METHOD

This study was conducted in Ethiopia based on the fifth Ethiopian Demographic and Health Surveys 2019 dataset. 8,663 households were successfully interviewed at a response rate of 99%. Weighted by sampling weight was done to do a reliable statistical analysis. Fuel type was used as the outcome variable whereas sex of household head (male or female), wealth index (poor, middle, and rich), educational status (no education, primary, secondary, higher), having television and radio, a separate room used as a kitchen, were individual predictor variables and community level education(lower/higher), residence(urban/rural), community level media exposure (exposed/unexposed), region (pastoralist, semi-pastoralist, Agrarian, and City administration) were community level variables. All the above analyses were conducted using Excel Microsoft 2016, STATA 14, ArcGIS 10.7, and SaTScan 10.1 software.

RESULTS

The majority (72.62%) of household heads were males. The overall national level of solid fuel use was 87.13% (95% CI (86.4%-87.82%)). From this 87.13% of solid fuel use, 18.60% accounts for urban and 68.53% for rural parts of the country. Educational status, having television, accessing electricity, and wealth index were individual-level variables community-level education, type of residence, and region were community-level variables significantly associated factors towards solid fuel use in our study. Global (z-score = 33.109144, P-value <0.0001), local (hot spot, cluster, and outlier), and Spatial Scan statistical analyses revealed that there was a major geographical variation in solid fuel use across Ethiopia.

CONCLUSION

Based on this finding, the prevalence of solid fuel use was higher in Ethiopia. Educational status, having television, accessing electricity, and wealth index were individual-level variables and community-level education, type of residence, and region were community-level variables statistically significant factors in determining fuel choice for cooking. There was significant spatial variation in the prevalence of solid-fuel use across the country. In order to addressing such heavily dependent on solid fuel use, responsible bodies like health policy makers, national and international organizations, and public health researchers should work on showing health problems of solid fuel use and the means of increasing clean fuel use. Substantial policy modifications are desirable to reach access to clean fuels and technologies (SDG 7.1.2) by 2030 to address health inequities.

The effect of living environmental factors on cardiovascular diseases in Chinese adults: results from a cross-sectional and longitudinal study

AIMS

This study aimed to investigate the association between multiple living environmental factors and cardiovascular diseases (CVDs).

METHODS AND RESULTS

This study was conducted on the China Health and Retirement Longitudinal Study (CHARLS), with 12 489 subjects in the cross-sectional study and 7932 subjects in the 7-year follow-up. Living environmental factors included ambient fine particulate matter (PM2.5), indoor fuel use, tap water use, and residence type. Logistic regression and Cox proportional hazard regression models were applied to explore the association between living environmental risk factors and CVD events in a cross-sectional and a cohort analysis, respectively. Compared with subjects in the low-risk groups, those in the middle-risk (odd ratio [OR], 95% confidence interval [CI]: 1.203, 0.943-1.534) and high-risk groups (OR, 95% CI: 1.616, 1.259-2.074) showed increased risks of CVD prevalence when considering the combined effects of their living environment. During the follow-up, similar associations were observed (hazard ratio [HR], 1.541, 95% CI [1.142-2.080] for the high-risk group; HR 1.296, 95% CI [0.968-1.736] for the middle-risk group); P for trend = 0.003).

CONCLUSION

An overall poor living environmental quality is a potential risk factor for CVD. Future studies should focus more on the effects of exposure to multiple factors.

Household solid fuel use and stroke incidence: Evidence from a national cohort study

Stroke is one of the leading causes of global mortality and disability. No specific study has focused on the association between household solid fuel use for different purposes and incident stroke. Therefore, we explored the associations between household solid fuel use purposes and switches and incident stroke based on a national prospective cohort study. There were 12,485 participants included in this study after exclusions. The incidence density of stroke was 8.29 for every 1,000 person-years. Household solid fuel use simultaneously for heating and cooking had the largest hazard effect on stroke occurrence [hazard ratio (HR), 1.35; 95% confidence interval (CI), 1.07, 1.70] with a significant linear trend (P < 0.01). Solid fuel use for cooking was significantly associated with increased risk of stroke occurrence (HR, 1.27; 95% CI, 1.06, 1.51). Persistent clean fuel use for both heating and cooking associated with a lower risk of stroke occurrence (HR, 0.79; 95% CI: 0.64, 0.99), and switching from solid fuel to clean-fuel use for cooking associated with a lower risk of stroke occurrence (HR, 0.89; 95% CI, 0.73, 1.09) compared with persistent solid fuel use. Effective measures to improve the household cooking environment may be necessary to prevent incident stroke.