TY - JOUR
T1 - Overall and cause-specific mortality rates among men and women with high exposure to indoor air pollution from the use of smoky and smokeless coal
T2 - a cohort study in Xuanwei, China
AU - Nagaradona, Teja
AU - Bassig, Bryan A
AU - Hosgood, Dean
AU - Vermeulen, Roel C H
AU - Ning, Bofu
AU - Seow, Wei Jie
AU - Hu, Wei
AU - Portengen, Lützen
AU - Wong, Jason
AU - Shu, Xiao-Ou
AU - Zheng, Wei
AU - Appel, Nathan
AU - Gao, Yu-Tang
AU - Cai, Qiu-Yin
AU - Yang, Gong
AU - Chen, Ying
AU - Downward, George
AU - Li, Jihua
AU - Yang, Kaiyun
AU - McCullough, Lauren
AU - Silverman, Debra
AU - Huang, Yunchao
AU - Lan, Qing
N1 - Funding Information:
The study was supported by the Chinese Academy of Preventive Medicine, Beijing, China, by the Yunnan Province Antiepidemic Station, Kunming, China, by contract 5D2290NFFX from the US Environmental Protection Agency, and by grant 1U01CA242740 from the US National Cancer Institute. This study was also supported by the Intramural Research Program of the National Cancer Institute, National Institutes of Health.
Publisher Copyright:
© 2022 BMJ Publishing Group. All rights reserved.
PY - 2022/11/15
Y1 - 2022/11/15
N2 - OBJECTIVES: Never-smoking women in Xuanwei (XW), China, have some of the highest lung cancer rates in the country. This has been attributed to the combustion of smoky coal used for indoor cooking and heating. The aim of this study was to evaluate the spectrum of cause-specific mortality in this unique population, including among those who use smokeless coal, considered 'cleaner' coal in XW, as this has not been well-characterised.DESIGN: Cohort study.SETTING: XW, a rural region of China where residents routinely burn coal for indoor cooking and heating.PARTICIPANTS: Age-adjusted, cause-specific mortality rates between 1976 and 2011 were calculated and compared among lifetime smoky and smokeless coal users in a cohort of 42 420 men and women from XW. Mortality rates for XW women were compared with those for a cohort of predominately never-smoking women in Shanghai.RESULTS: Mortality in smoky coal users was driven by cancer (41%), with lung cancer accounting for 88% of cancer deaths. In contrast, cardiovascular disease (CVD) accounted for 32% of deaths among smokeless coal users, with 7% of deaths from cancer. Total cancer mortality was four times higher among smoky coal users relative to smokeless coal users, particularly for lung cancer (standardised rate ratio (SRR)=17.6). Smokeless coal users had higher mortality rates of CVD (SRR=2.9) and pneumonia (SRR=2.5) compared with smoky coal users. These patterns were similar in men and women, even though XW women rarely smoked cigarettes. Women in XW, regardless of coal type used, had over a threefold higher rate of overall mortality, and most cause-specific outcomes were elevated compared with women in Shanghai.CONCLUSIONS: Cause-specific mortality burden differs in XW based on the lifetime use of different coal types. These observations provide evidence that eliminating all coal use for indoor cooking and heating is an important next step in improving public health particularly in developing countries.
AB - OBJECTIVES: Never-smoking women in Xuanwei (XW), China, have some of the highest lung cancer rates in the country. This has been attributed to the combustion of smoky coal used for indoor cooking and heating. The aim of this study was to evaluate the spectrum of cause-specific mortality in this unique population, including among those who use smokeless coal, considered 'cleaner' coal in XW, as this has not been well-characterised.DESIGN: Cohort study.SETTING: XW, a rural region of China where residents routinely burn coal for indoor cooking and heating.PARTICIPANTS: Age-adjusted, cause-specific mortality rates between 1976 and 2011 were calculated and compared among lifetime smoky and smokeless coal users in a cohort of 42 420 men and women from XW. Mortality rates for XW women were compared with those for a cohort of predominately never-smoking women in Shanghai.RESULTS: Mortality in smoky coal users was driven by cancer (41%), with lung cancer accounting for 88% of cancer deaths. In contrast, cardiovascular disease (CVD) accounted for 32% of deaths among smokeless coal users, with 7% of deaths from cancer. Total cancer mortality was four times higher among smoky coal users relative to smokeless coal users, particularly for lung cancer (standardised rate ratio (SRR)=17.6). Smokeless coal users had higher mortality rates of CVD (SRR=2.9) and pneumonia (SRR=2.5) compared with smoky coal users. These patterns were similar in men and women, even though XW women rarely smoked cigarettes. Women in XW, regardless of coal type used, had over a threefold higher rate of overall mortality, and most cause-specific outcomes were elevated compared with women in Shanghai.CONCLUSIONS: Cause-specific mortality burden differs in XW based on the lifetime use of different coal types. These observations provide evidence that eliminating all coal use for indoor cooking and heating is an important next step in improving public health particularly in developing countries.
KW - Epidemiology
KW - Health & safety
KW - Public health
UR - http://www.scopus.com/inward/record.url?scp=85141991835&partnerID=8YFLogxK
U2 - 10.1136/bmjopen-2021-058714
DO - 10.1136/bmjopen-2021-058714
M3 - Article
C2 - 36379646
SN - 2044-6055
VL - 12
JO - BMJ Open
JF - BMJ Open
IS - 11
M1 - e058714
ER -