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Solid fuel sources tied to increased risk for death, CV death
Solid fuel sources, commonly used for cooking and heating, correlated with increased risk for CV and all-cause mortality in rural China, according to new research published in JAMA.
“The mechanisms through which solid fuel use may contribute to mortality risk are not well understood,” Kuai Yu, MD, from Key Laboratory of Environment and Health, Ministry of Education and State Key Laboratory of Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China, and colleagues wrote in the study background. “Burning of solid fuels releases substantially higher levels of various gaseous pollutants and PM2.5 than clean fuel and it might increase cardiovascular disease and mortality risk through pathways such as cardiac autonomic dysfunction and atherothrombosis.”
To assess the association between solid fuel and CV and all-cause mortality, Yu and colleagues conducted a nationwide prospective cohort study comprising 271,217 adults (mean age, 51 years; 59% women) who did not have a self-reported history of physician-diagnosed CVD at baseline. A random subset of 10,892 adults participated in a resurvey after a mean of 2.7 years.
The primary endpoints were CV death and all-cause death, which the researchers measured collecting established death registries.
The researchers observed that 66% of participants reported cooking at least weekly, and of those, 84% used solid fuels; and 60% reported heating their houses in winter, of whom 90% used solid fuels.
Over a mean 7.2 years of follow-up, 15,468 deaths occurred, of which 5,519 were from CV causes.
Risk for CV mortality was increased by use of solid fuels for cooking (absolute rate difference per 100,000-person years = 135; 95% CI, 77-193; HR = 1.2, 95% CI, 1.02-1.41), as was risk for all-cause mortality (absolute rate difference per 100,000-person years = 338; 95% CI, 249-487; HR = 1.11, 95% CI, 1.03-1.2), according to the researchers.
Use of solid fuels for heating was also associated with elevated risk for CV mortality (absolute rate difference per 100,000-person years = 175; 95% CI, 118-231; HR = 1.29, 95% CI, 1.06-1.55) and all-cause mortality (absolute rate difference per 100,000-person years = 392; 95% CI, 297-487; HR = 1.14, 95% CI, 1.03-1.26), they found.
The researchers observed a lower risk for CV mortality and all-cause mortality among participants who reported having switched from solid to clean fuels for cooking (HR for CV mortality = 0.83; 95% CI, 0.69-0.99; HR for all-cause mortality = 0.87; 95% CI, 0.79-0.95) and heating (HR for CV mortality = 0.57; 95% CI, 0.42-0.77; HR for all-cause mortality = 0.67; 95% CI, 0.57-0.79).
Among those who cooked with solid fuels, participants who used a ventilated cookstove had lower risk for CV mortality (HR = 0.89; 95% CI, 0.8-0.99) and all-cause mortality (HR = 0.91; 95% CI, 0.85-0.96) compared with those who did not, Yu and colleagues wrote.
“To our knowledge, this is the first study to assess the mortality risk associated with cooking and heating separately, their additive interactions with smoking, switching from solid fuels to clean fuels and use of appropriate ventilation,” the researchers wrote. by Dave Quaile
Disclosures: The study was funded by grants from the National Natural Science Foundation of China. The authors report no relevant financial disclosures.