Health Effects of Household Solid Fuel Use: Findings from 11 Countries within the Prospective Urban and Rural Epidemiology Study

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. https://doi.org/10.1289/EHP3915

The role of cities in reducing the cardiovascular impacts of environmental pollution in low- and middle-income countries

“…Several studies separately evaluated the CVD impacts of solid fuel stove use [42][43][44][45]. In China, solid fuel stove use was associated with a greater risk of CVD mortality (range of hazard ratios (HRs): 1.20-1.29) [44].…”

“…In Iran, the use of kerosene stoves was positively associated with CVD mortality (HR: 1.11) in adults, though no association was observed for wood-stove users [46]. Most recently, a multi-country cohort study observed an increased risk of CVD hospitalizations, fatal and nonfatal events, and CVD mortality (range of HRs: 1.04-1.10) among users of solid fuel cookstoves [43]. These studies are supported by studies of subclinical CVD endpoints showing higher levels of inflammatory markers, blood pressure, and arterial stiffness in women using solid fuel stoves and with higher PM 2.5 exposures, with larger associations in older age [42,[47][48][49].…”

Household, community, sub-national and country-level predictors of primary cooking fuel switching in nine countries from the PURE study

“…The use of polluting cooking fuels presents a serious global health risk due to household air pollution (HAP) exposure. Elevated levels of fine particulate matter of diameter <2.5 mm (PM 2.5 ) due to HAP (HAP-PM 2.5 ) have been linked to respiratory diseases (child pneumonia [3], COPD [4] and lung cancer [5]), adverse pregnancy outcomes [6,7], cataracts [8], precursors to cardiovascular diseases (CVD), including hypertension [9], and to CVD [10][11][12][13]. Exposure to HAP was the second highest environmental risk factor in the Global Burden of Disease 2017 [14], with an estimated 1.64 million attributable deaths [1,15].…”

A feasibility study of metabolic phenotyping of dried blood spot specimens in rural Chinese women exposed to household air pollution

“…In this cohort of female participants, use of biomass fuel for cooking and heating generated high levels of air pollution that exceed air pollution levels in most urban settings [51] and were 2-8 times higher than the World Health Organization (WHO) health target of 35 μg/m 3 for PM 2.5 [52]. Exposure to air pollutants from biomass stoves have been associated with higher blood pressure in women [53,54] and solid fuel users reported higher incidence and mortality in cardiorespiratory diseases when compared with clean fuel users [3,55]. Although we did not confirm the association of uric acid and/or adenosine to chronic diseases, our pilot work does set the stage for further examination of the underpinning mechanism of HAP exposure and the potential clinical relevance of these discriminatory metabolites.…”