Household fuel types and nonfatal cardiovascular diseases in middle-aged and elderly adults.
Source: PubMed, NCBI / U.S. National Library of Medicine
Solid fuel-related household air pollution is a major health concern globally. However, the specific cardiovascular risks associated with different types of solid fuel, and whether a healthy lifestyle can mitigate these risks in middle-aged and elderly adults, remain unclear. Therefore, this study aimed to examine the association between household solid fuel use and incident nonfatal cardiovascular diseases (CVD) and to assess the potential modifying role of a healthy lifestyle. This prospective cohort study included 7671 participants from the China Health and Retirement Longitudinal Study (2011-2020) who were free of CVD at baseline. Household solid fuel exposure was defined by the use of solid fuel (coal, crop residue or wood) for heating and cooking, and clean fuel use was treated as the reference category. A healthy lifestyle score was constructed based on four behavioral factors. Cox proportional hazards models were used to evaluate associations, with stratified analyses examining effect modification by lifestyle. Among the 7671 eligible participants, 74.0% and 54.8% reported using solid fuel for heating or cooking, respectively. After adjustment for confounders, the use of crop residue or wood (HR: 1.32, 95% CI: 1.10, 1.59) and coal (HR: 1.53, 95% CI: 1.28, 1.82) for heating was associated with an increased risk of nonfatal CVD. For cooking, only coal use was associated with an increased risk (HR: 1.10, 95% CI: 1.01, 1.31). A healthy lifestyle appeared to attenuate the
Abstract
Solid fuel-related household air pollution is a major health concern globally. However, the specific cardiovascular risks associated with different types of solid fuel, and whether a healthy lifestyle can mitigate these risks in middle-aged and elderly adults, remain unclear. Therefore, this study aimed to examine the association between household solid fuel use and incident nonfatal cardiovascular diseases (CVD) and to assess the potential modifying role of a healthy lifestyle. This prospective cohort study included 7671 participants from the China Health and Retirement Longitudinal Study (2011-2020) who were free of CVD at baseline. Household solid fuel exposure was defined by the use of solid fuel (coal, crop residue or wood) for heating and cooking, and clean fuel use was treated as the reference category. A healthy lifestyle score was constructed based on four behavioral factors. Cox proportional hazards models were used to evaluate associations, with stratified analyses examining effect modification by lifestyle. Among the 7671 eligible participants, 74.0% and 54.8% reported using solid fuel for heating or cooking, respectively. After adjustment for confounders, the use of crop residue or wood (HR: 1.32, 95% CI: 1.10, 1.59) and coal (HR: 1.53, 95% CI: 1.28, 1.82) for heating was associated with an increased risk of nonfatal CVD. For cooking, only coal use was associated with an increased risk (HR: 1.10, 95% CI: 1.01, 1.31). A healthy lifestyle appeared to attenuate the adverse cardiovascular effects associated with solid fuel use for heating, particularly coal use (relative excess risk due to interaction: -1.78, 95% CI: -3.81, -0.31). In conclusion, household solid fuel use, especially coal use, was associated with an increased risk of nonfatal CVD. A healthy lifestyle might partially mitigate these adverse cardiovascular effects. These findings support strategies to promote clean household energy and healthy behaviors for CVD prevention in middle-aged and elderly adults.