Long-term solid fuel use and risks of major eye diseases in China: A population-based cohort study of 486,532 adults.
Long-term solid fuel use and risks of major eye diseases in China: A population-based cohort study of 486,532 adults.
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DOI：
10.1371/journal.pmed.1003716
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发表时间：
2021-07
期刊：
影响因子：
15.8
通讯作者：
China Kadoorie Biobank Study group
中科院分区：
文献类型：
--
作者：
Chan KH;Yan M;Bennett DA;Guo Y;Chen Y;Yang L;Lv J;Yu C;Pei P;Lu Y;Li L;Du H;Lam KBH;Chen Z;China Kadoorie Biobank Study group
全球有超过35亿人因使用固体燃料而暴露在家庭空气污染中。关于使用固体燃料与重大眼病风险之间的关联的队列研究提供的证据有限，这些疾病会在全球范围内造成重大疾病和经济负担。2004年至2008年，中国嘉道理生物库从中国的10个地区招募了512,715名年龄在30岁至79岁之间的成年人。通过问卷调查，对最近3个住宅的烹饪频率和主要燃料类型进行了评估。在中位数(IQR)10.1年(9.2至11.1年)的随访中，与国家医疗保险数据库的电子链接发现了4877例结膜疾病、13408例白内障、1583例巩膜、角膜、虹膜和睫状体(DSCIC)疾病以及1534例青光眼。Logistic回归得到长期使用固体燃料(即煤或木材)与烹饪用清洁燃料(即燃气或电力)相关的每种疾病的优势比(OR)，并根据基线年龄、出生队列、性别、研究地区、教育、职业、饮酒、吸烟、环境烟草烟雾、炉灶通风、取暖燃料暴露、体重指数、糖尿病流行情况、自我报告的一般健康状况和召回时间长短进行调整。在排除缺少或不可靠暴露数据的参与者后，对486,532名参与者(平均基线年龄52.0[SD 10.7]岁；59.1%女性)进行了分析。总体而言，71%的参与者在召回期间经常做饭，其中48%的人始终如一地使用固体燃料。与清洁燃料使用者相比，固体燃料使用者对结膜疾病的调整比为1.32(1.07~1.37，p<；0.001)，对白内障的调整比为1.17(1.08~1.26，p<；0.001)，对散发性白内障的调整比为1.35(1.10~1.66，p=0.0046)，对青光眼的调整比为0.95(0.76~1.18，p=0.62)。在长期使用清洁燃料的人中，从固体燃料转换为清洁燃料的风险比不转换燃料的风险更小，结膜疾病、白内障和弥漫性晶状体上皮细胞癌的调整OR值分别为1.21(1.07至1.37，p<；0.001)、1.05(0.98至1.12，p=0.17)和1.21(0.97至1.5，p=0.088)。在固体燃料使用者中，无论通风状况如何，眼部疾病的调整后OR大体相似。这项研究的主要局限性包括缺乏对眼病的基线评估，使用自我报告的烹饪频率和燃料类型进行暴露评估，延迟诊断产生偏差的风险(特别是对白内障)，以及来自无法测量的因素(例如，阳光暴露)的潜在残留混杂。在中国成年人中，长期使用固体燃料做饭不仅与结膜疾病相关，而且与白内障和其他更严重的眼病有关。改用清洁燃料似乎降低了风险，突显了促进普遍获得清洁燃料对全球健康的重要性。陈嘉鸿和他的同事研究了使用固体燃料做饭与中国眼疾之间的关系。使用固体燃料造成的家庭空气污染与患白内障和一系列急性眼部症状的风险更高有关，但之前的大多数研究使用的是相对粗糙的暴露评估方法和横断面或病例对照设计，而且规模相对较小。长期使用固体燃料与白内障以外的常见眼病的关系，包括结膜疾病、角膜炎和青光眼，目前还知之甚少。我们分析了2004年至2008年从中国10个地区招募到中国嘉道理生物库的486,532名30岁至79岁的成年人的数据，以评估自我报告的长期烹饪固体燃料与结膜炎、白内障、巩膜、角膜、虹膜和睫状体疾病以及青光眼风险的相关性。使用多变量Logistic回归来估计长期使用清洁燃料和固体燃料的人，以及在初始基线调查之前从固体燃料转为清洁燃料的人的优势比。长期使用固体燃料与结膜疾病、白内障和DSCIC的风险分别高出32%、17%和35%，但与青光眼无关。从固体燃料转向清洁燃料的人似乎比那些持续使用固体燃料的人风险更小。据我们所知，这是关于长期使用固体燃料与多种常见眼病风险之间关系的首批队列研究之一。我们的发现支持使用固体燃料与白内障之间的显著关联，但与之前的研究相比，这种关联似乎要弱得多；与结膜疾病和DSCIC的关联表明，使用固体燃料可能会对眼睛健康造成更广泛的损害，这一点应该进一步调查。
Over 3.5 billion individuals worldwide are exposed to household air pollution from solid fuel use. There is limited evidence from cohort studies on associations of solid fuel use with risks of major eye diseases, which cause substantial disease and economic burden globally. The China Kadoorie Biobank recruited 512,715 adults aged 30 to 79 years from 10 areas across China during 2004 to 2008. Cooking frequency and primary fuel types in the 3 most recent residences were assessed by a questionnaire. During median (IQR) 10.1 (9.2 to 11.1) years of follow-up, electronic linkages to national health insurance databases identified 4,877 incident conjunctiva disorders, 13,408 cataracts, 1,583 disorders of sclera, cornea, iris, and ciliary body (DSCIC), and 1,534 cases of glaucoma. Logistic regression yielded odds ratios (ORs) for each disease associated with long-term use of solid fuels (i.e., coal or wood) compared to clean fuels (i.e., gas or electricity) for cooking, with adjustment for age at baseline, birth cohort, sex, study area, education, occupation, alcohol intake, smoking, environmental tobacco smoke, cookstove ventilation, heating fuel exposure, body mass index, prevalent diabetes, self-reported general health, and length of recall period. After excluding participants with missing or unreliable exposure data, 486,532 participants (mean baseline age 52.0 [SD 10.7] years; 59.1% women) were analysed. Overall, 71% of participants cooked regularly throughout the recall period, of whom 48% used solid fuels consistently. Compared with clean fuel users, solid fuel users had adjusted ORs of 1.32 (1.07 to 1.37, p < 0.001) for conjunctiva disorders, 1.17 (1.08 to 1.26, p < 0.001) for cataracts, 1.35 (1.10 to 1.66, p = 0.0046) for DSCIC, and 0.95 (0.76 to 1.18, p = 0.62) for glaucoma. Switching from solid to clean fuels was associated with smaller elevated risks (over long-term clean fuel users) than nonswitching, with adjusted ORs of 1.21 (1.07 to 1.37, p < 0.001), 1.05 (0.98 to 1.12, p = 0.17), and 1.21 (0.97 to 1.50, p = 0.088) for conjunctiva disorders, cataracts, and DSCIC, respectively. The adjusted ORs for the eye diseases were broadly similar in solid fuel users regardless of ventilation status. The main limitations of this study include the lack of baseline eye disease assessment, the use of self-reported cooking frequency and fuel types for exposure assessment, the risk of bias from delayed diagnosis (particularly for cataracts), and potential residual confounding from unmeasured factors (e.g., sunlight exposure). Among Chinese adults, long-term solid fuel use for cooking was associated with higher risks of not only conjunctiva disorders but also cataracts and other more severe eye diseases. Switching to clean fuels appeared to mitigate the risks, underscoring the global health importance of promoting universal access to clean fuels. Ka Hung Chan and co-workers study associations between use of solid fuel for cooking and eye disorders in China. Household air pollution from solid fuel use has been linked to higher risks of cataracts and a range of acute eye symptoms, but most previous studies used relatively crude exposure assessment methods and cross-sectional or case–control designs and were relatively small. The relationships of long-term solid fuel use with common eye diseases other than cataracts, including conjunctiva disorders, keratitis, and glaucoma, are poorly understood. We analysed data from 486,532 adults aged 30 to 79 years recruited from 10 areas of China into the China Kadoorie Biobank during 2004 to 2008 to assess the associations of self-reported long-term solid fuel use for cooking with risks of conjunctivitis, cataracts, disorders of sclera, cornea, iris and ciliary body (DSCIC), and glaucoma during approximately 10-year follow-up. Multivariable logistic regression was used to estimate odds ratios comparing long-term clean fuels and solid fuels users, as well as those who had switched from solid to clean fuels prior to the initial baseline survey. Long-term solid fuel use was associated with 32%, 17%, and 35% higher risks of conjunctiva disorders, cataracts, and DSCIC, respectively, but not associated with glaucoma. Individuals who had switched from solid to clean fuels appeared to have smaller risks than those who used solid fuels persistently. To our knowledge, this is one of the first cohort studies on the relationships between long-term solid fuel use and risks of multiple common eye diseases. Our findings support a significant association between solid fuel use and cataracts, but the strength of association appeared to be considerably weaker compared to that observed in previous studies; the associations with conjunctiva disorders and DSCIC indicate that solid fuel use may have more extensive harm on eye health, which should be further investigated.
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DOI：
10.1016/s0140-6736(15)00340-2
发表时间：
2015-10-10
期刊：
Lancet (London, England)
影响因子：
--
作者：
Chen Z;Peto R;Zhou M;Iona A;Smith M;Yang L;Guo Y;Chen Y;Bian Z;Lancaster G;Sherliker P;Pang S;Wang H;Su H;Wu M;Wu X;Chen J;Collins R;Li L;China Kadoorie Biobank (CKB) collaborative group
通讯作者：
China Kadoorie Biobank (CKB) collaborative group
影响因子：
1.8
作者：
Delavar, Arash;Freedman, D. Michal;Cahoon, Elizabeth K.
通讯作者：
Cahoon, Elizabeth K.
影响因子：
168.9
作者：
Pirie, Kirstin;Peto, Richard;Beral, Valerie
通讯作者：
Beral, Valerie
影响因子：
168.9
作者：
Millwood, Iona Y.;Walters, Robin G.;Chen, Zhengming
通讯作者：
Chen, Zhengming
影响因子：
4.6
作者：
Karakocak, Bedia Begum;Patel, Sameer;Biswas, Pratim
通讯作者：
Biswas, Pratim