Bryan A Bassig1, H Dean Hosgood2, Xiao-Ou Shu3, Roel Vermeulen4, Bingshu E Chen5, Hormuzd A Katki1, Wei Jie Seow6,7, Wei Hu1, Lützen Portengen4, Bu-Tian Ji1, Jason Y Y Wong1, Bofu Ning8, George S Downward4, Jihua Li9, Kaiyun Yang10, Gong Yang3, Yu-Tang Gao11, Yong-Bing Xiang12, Teja Nagaradona1, Wei Zheng3, Debra T Silverman1, Yunchao Huang10, Qing Lan1. 1. Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA. 2. Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, NY, USA. 3. Division of Epidemiology, Vanderbilt Epidemiology Center, Vanderbilt University School of Medicine, Nashville, TN, USA. 4. Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands. 5. Department of Public Health Sciences, Queen's University, Kingston, ON, Canada. 6. Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore. 7. Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore. 8. Xuanwei Center for Disease Control and Prevention, Xuanwei, Qujing, Yunnan, China. 9. Qujing Center for Diseases Control and Prevention, Sanjiangdadao, Qujing, Yunnan, China. 10. Third Affiliated Hospital of Kunming Medical University (Yunnan Tumor Hospital), Kunming, China. 11. Department of Epidemiology, Shanghai Cancer Institute, Shanghai Jiaotong University, Shanghai, China. 12. State Key Laboratory of Oncogene and Related Genes & Department of Epidemiology, Shanghai Cancer Institute, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Abstract
BACKGROUND: Lifetime use of bituminous ('smoky') coal is associated with nearly a 100-fold higher risk of lung cancer mortality compared with anthracite ('smokeless') coal use in rural Xuanwei, China, among women. Risk of mortality from ischaemic heart disease (IHD) and stroke for these coal types has not been evaluated. METHODS: A cohort of 16 323 non-smoking women in Xuanwei, who were lifetime users of either smoky or smokeless coal, were followed up from 1976 to 2011. We estimated hazard ratios (HRs) and 95% confidence intervals (CI) to evaluate lifetime use of coal types and stoves in the home in relation to risk of IHD and stroke mortality. RESULTS: Among lifetime users of smokeless coal, higher average exposure intensity (≥4 tons/year vs <2.5 tons/year, HR = 7.9, 95% CI = 3.5-17.8; Ptrend =<0.0001) and cumulative exposure (>64 ton-years vs ≤28 ton-years, HR = 6.5, 95% CI = 1.5-28.3; Ptrend =0.003) during follow-up and over their lifetime was associated with increased IHD mortality, and ventilated stove use dramatically reduced this risk (HR = 0.2, 95% CI 0.1-0.5). Higher cumulative exposure to smoky coal during follow-up showed positive associations with IHD mortality, but the evidence for other metrics was less consistent compared with associations with smokeless coal use. CONCLUSIONS: Higher use of smokeless coal, which is burned throughout China and is generally regarded to be a cleaner fuel type, is associated with IHD mortality. Use of cleaner fuels or stove interventions may be effective in reducing the increasing burden of IHD in developing regions that currently rely on smokeless coal for cooking and heating. Published by Oxford University Press on behalf of the International Epidemiological Association 2019. This work is written by US Government employees and is in the public domain in the US.
BACKGROUND: Lifetime use of bituminous ('smoky') coal is associated with nearly a 100-fold higher risk of lung cancer mortality compared with anthracite ('smokeless') coal use in rural Xuanwei, China, among women. Risk of mortality from ischaemic heart disease (IHD) and stroke for these coal types has not been evaluated. METHODS: A cohort of 16 323 non-smoking women in Xuanwei, who were lifetime users of either smoky or smokeless coal, were followed up from 1976 to 2011. We estimated hazard ratios (HRs) and 95% confidence intervals (CI) to evaluate lifetime use of coal types and stoves in the home in relation to risk of IHD and stroke mortality. RESULTS: Among lifetime users of smokeless coal, higher average exposure intensity (≥4 tons/year vs <2.5 tons/year, HR = 7.9, 95% CI = 3.5-17.8; Ptrend =<0.0001) and cumulative exposure (>64 ton-years vs ≤28 ton-years, HR = 6.5, 95% CI = 1.5-28.3; Ptrend =0.003) during follow-up and over their lifetime was associated with increased IHD mortality, and ventilated stove use dramatically reduced this risk (HR = 0.2, 95% CI 0.1-0.5). Higher cumulative exposure to smoky coal during follow-up showed positive associations with IHD mortality, but the evidence for other metrics was less consistent compared with associations with smokeless coal use. CONCLUSIONS: Higher use of smokeless coal, which is burned throughout China and is generally regarded to be a cleaner fuel type, is associated with IHD mortality. Use of cleaner fuels or stove interventions may be effective in reducing the increasing burden of IHD in developing regions that currently rely on smokeless coal for cooking and heating. Published by Oxford University Press on behalf of the International Epidemiological Association 2019. This work is written by US Government employees and is in the public domain in the US.
Entities:
Keywords:
Chinese cohort; Solid fuels; cardiovascular disease; coal; indoor air pollution; stove improvement
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