Solid Fuel Use and Risks of All‐Cause and Cardiovascular Disease Mortality in Urban Northern China: A 12‐Year Cohort Study
Hongyue Sun, Yinuo Li, Zongqi Chi, Xiaofeng Zhang, Yishu Yang, Jia Ding, Honglu Zhang, Huajie Yang, Zinuo Wang, Yiqing Wang, Jingting Chen, Christiana Asante, Xuejiao Lv, Xueli Yang, Liwen Zhang, Xi Chen, Guanghui Dong, Qiang Zeng, Yamin Liu, Jie Chen, Tong Wang, Baoxin Zhao, Zhipeng Bai, Anqi Shan, Nai-Jun TangBackground
Indoor pollution poses a potential health threat due to prolonged exposure, but evidence linking it to mortality from a wide range of cardiovascular subtypes remains limited, particularly in urban areas.
Objectives
This study is aimed at examining the association between indoor use of nonclean energy and various subtypes of cardiovascular mortality, and at identifying vulnerable populations, thereby providing scientific evidence for policymaking during energy transitions.
Method
This retrospective cohort study was conducted in four northern Chinese cities, namely, Tianjin, Shenyang, Taiyuan, and Rizhao, to track all‐cause and selected cardiovascular mortality between 1998 and 2009. A Cox proportional hazards model was applied to assess the association between solid fuel use for cooking and heating and mortality from multiple cardiovascular subtypes, including total cardiovascular disease, cerebrovascular disease, ischemic heart disease, and heart failure. Stratified analyses were conducted to identify vulnerable subpopulations.
Results
During the 12‐year follow‐up of 39,054 participants, 1435 deaths (3.67%) from nonaccidental causes were recorded, including 677 (1.73%) from cardiovascular disease, 296 (0.76%) from cerebrovascular disease, 162 (0.41%) from ischemic heart disease, and 109 (0.28%) from heart failure. In the fully adjusted model, each additional year of solid fuel use for heating was associated with increased risks of nonaccidental mortality (hazard ratio [HR]: 1.15; 95% confidence interval [CI]: 1.14, 1.17), cardiovascular mortality (HR: 1.15; 95% CI: 1.13, 1.18), and cerebrovascular mortality (HR: 1.16; 95% CI: 1.12, 1.20). Similar associations were found for cooking with nonclean energy, with HRs slightly higher than those for heating. Individuals aged 60 years and older appeared to be more sensitive to pollution from nonclean energy sources.
Conclusions
The use of nonclean energy for heating and cooking was positively associated with mortality across multiple cardiovascular subtypes, and vulnerable populations were identified through stratified analyses. These findings offer valuable evidence for developing countries undergoing energy transitions. However, because this historical cohort was followed from 1998 to 2009, the findings may have limited generalizability to contemporary China, where household energy use, ambient air quality, and population health profiles have changed substantially.