Health benefits from reducing indoor air pollution from household solid fuel use in China--three abatement scenarios.

According to the World Health Organization (WHO), indoor air pollution (IAP) from the use of solid fuels in households in the developing world is responsible for more than 1.6 million premature deaths each year, whereof 0.42 million occur in China alone. We argue that the methodology applied by WHO--the so-called fuel-based approach--underestimates the health effects, and suggest an alternative method. Combining exposure-response functions and current mortality and morbidity rates, we estimate the burden of disease of IAP in China and the impacts of three abatement scenarios. Using linear exposure-response functions, we find that 3.5 [0.8-14.7 95% CI] million people die prematurely due to IAP in China each year. The central estimate constitutes 47% of all deaths in China. We find that modest changes in the use of cooking fuels in rural households might have a large health impact, reducing annual mortality by 0.63 [0.1-3. 2 95% CI] million. If the indoor air quality (IAQ) standard set by the Chinese government (150 microg PM(10)/m(3)) was met in all households, we estimate that 0.9 [0.2-4.8] million premature deaths would be avoided in urban areas and 2.8 [0.7-12.4] million in rural areas. However, in urban areas this would require improvements to the outdoor air quality in addition to a complete fuel switch to clean fuels in households. We estimate that a fuel switch in urban China could prevent 0.7 [0.2-4.8] million premature deaths. The methodology for exposure assessment applied here is probably more realistic than the fuel-based approach; however, the use of linear exposure-response relationships most likely tends to overestimate the effects. The discrepancies between our results and the WHO estimates is probably also explained by our use of "all-cause mortality" which includes important causes of death like cardiovascular diseases, conditions known to be closely associated with exposure to particulate pollution, whereas the WHO estimate is limited to respiratory diseases.