Coal use, stove improvement, and adult pneumonia mortality in Xuanwei, China: a retrospective cohort study.
Coal use, stove improvement, and adult pneumonia mortality in Xuanwei, China: a retrospective cohort study.
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DOI：
10.1289/ehp.11521
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发表时间：
2009-02
影响因子：
10.4
通讯作者：
Lan Q
中科院分区：
文献类型：
--
作者：
Shen M;Chapman RS;Vermeulen R;Tian L;Zheng T;Chen BE;Engels EA;He X;Blair A;Lan Q
在中国宣威县，未通风的室内燃煤与肺癌和慢性阻塞性肺病的风险增加密切相关。然而，燃煤和炉灶改进对肺炎风险的影响尚不清楚。我们对 1917 年至 1951 年出生、截至 1976 年 1 月 1 日居住在宣威的所有农民进行了回顾性队列研究。该分析总共包括 42,422 名队列成员。随访确定了 1976 年至 1996 年队列中的所有死亡。进入和退出随访时的年龄分别为 24 至 59 岁和 25 至 80 岁。截至 1996 年 12 月 31 日，记录搜索发现有 225 例死于肺炎，其中 32,332 例 (76%) 还活着。我们构建了多变量 Cox 模型（时间变量 = 年龄）来估计风险比 (HR) 和 95% 置信区间 (CI)。煤炭的使用，尤其是无烟煤，与肺炎死亡率呈正相关。有烟煤和无烟煤的年吨位和寿命持续时间与肺炎死亡率呈正相关。炉灶的改进与肺炎死亡人数减少 50% 相关（烟煤使用者：HR，0.521；95% CI，0.340–0.798；无烟煤使用者：HR，0.449；95% CI，0.215–0.937）。我们的分析首次表明，未通风的燃煤造成的室内空气污染是成人肺炎死亡的重要危险因素，而通过安装烟囱改善通风是减少污染的有效措施。
In Xuanwei County, China, unvented indoor coal burning is strongly associated with increased risk of lung cancer and chronic obstructive pulmonary disease. However, the impact of coal burning and stove improvement on risk of pneumonia is not clear. We conducted a retrospective cohort study among all farmers born 1917 through 1951 and living in Xuanwei as of 1 January 1976. The analysis included a total of 42,422 cohort members. Follow-up identified all deaths in the cohort from 1976 through 1996. Ages at entry into and at exit from follow-up ranged from 24 to 59 years and from 25 to 80 years, respectively. The record search detected 225 deaths from pneumonia, and 32,332 (76%) were alive as of 31 December 1996. We constructed multivariable Cox models (time variable = age) to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). Use of coal, especially smokeless coal, was positively associated with pneumonia mortality. Annual tonnage and lifetime duration of smoky and smokeless coal use were positively associated with pneumonia mortality. Stove improvement was associated with a 50% reduction in pneumonia deaths (smoky coal users: HR, 0.521; 95% CI, 0.340–0.798; smokeless coal users: HR, 0.449; 95% CI, 0.215–0.937). Our analysis is the first to suggest that indoor air pollution from unvented coal burning is an important risk factor for pneumonia death in adults and that improving ventilation by installing a chimney is an effective measure to decrease it.