Solid Fuel Use and Risks of Respiratory Diseases. A Cohort Study of 280,000 Chinese Never-Smokers.
Solid Fuel Use and Risks of Respiratory Diseases. A Cohort Study of 280,000 Chinese Never-Smokers.
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DOI：
10.1164/rccm.201803-0432oc
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发表时间：
2019-02-01
影响因子：
24.7
通讯作者：
China Kadoorie Biobank Collaborative Group
中科院分区：
文献类型：
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作者：
Chan KH;Kurmi OP;Bennett DA;Yang L;Chen Y;Tan Y;Pei P;Zhong X;Chen J;Zhang J;Kan H;Peto R;Lam KBH;Chen Z;China Kadoorie Biobank Collaborative Group
理由：关于固体燃料使用与主要呼吸系统疾病住院和死亡率之间关系的大规模队列研究证据很少。目标：研究固体燃料的使用与急性和慢性呼吸道疾病风险的关联。方法：对 277,838 名基线时无重大慢性病的中国非吸烟者进行队列研究。在9年的随访期间，记录了19,823例因主要呼吸道疾病首次住院或死亡的病例，其中包括10,553例慢性下呼吸道疾病（CLRD）、4,398例慢性阻塞性肺疾病（COPD）和7,324例急性下呼吸道感染（ALRI）。 Cox 回归得出与自我报告的主要烹饪燃料使用相关的疾病风险的调整后风险比 (HR)。测量和主要结果：总体而言，91% 的参与者表示经常做饭，其中 52% 使用固体燃料。与清洁燃料使用者相比，固体燃料使用者对于主要呼吸道疾病的调整后 HR 为 1.36（95% 置信区间，1.32-1.40），而从固体燃料转向清洁燃料的使用者的 HR 较弱（1.14，1.10-1.17）。木材使用者（1.37、1.33–1.41）的 HR 高于煤炭使用者（1.22、1.15–1.29）和长期使用者（≥40 年，1.54、1.48–1.60；<20 年，1.32、1.26–1.39），但使用通风炉灶的人低于不通风炉灶的人（1.22， 1.19–1.25 与 1.29、1.24–1.35）。对于 CLRD、COPD 和 ALRI，与固体燃料使用相关的 HR 分别为 1.47 (1.41–1.52)、1.10 (1.03–1.18) 和 1.16 (1.09–1.23)。结论：在中国成年人中，使用固体燃料做饭与重大呼吸道疾病入院和死亡的风险较高相关，并且改用清洁燃料或使用通风炉灶的风险低于不改用的风险。
Rationale: Little evidence from large-scale cohort studies exists about the relationship of solid fuel use with hospitalization and mortality from major respiratory diseases. Objectives: To examine the associations of solid fuel use and risks of acute and chronic respiratory diseases. Methods: A cohort study of 277,838 Chinese never-smokers with no prior major chronic diseases at baseline. During 9 years of follow-up, 19,823 first hospitalization episodes or deaths from major respiratory diseases, including 10,553 chronic lower respiratory disease (CLRD), 4,398 chronic obstructive pulmonary disease (COPD), and 7,324 acute lower respiratory infection (ALRI), were recorded. Cox regression yielded adjusted hazard ratios (HRs) for disease risks associated with self-reported primary cooking fuel use. Measurements and Main Results: Overall, 91% of participants reported regular cooking, with 52% using solid fuels. Compared with clean fuel users, solid fuel users had an adjusted HR of 1.36 (95% confidence interval, 1.32–1.40) for major respiratory diseases, whereas those who switched from solid to clean fuels had a weaker HR (1.14, 1.10–1.17). The HRs were higher in wood (1.37, 1.33–1.41) than coal users (1.22, 1.15–1.29) and in those with prolonged use (≥40 yr, 1.54, 1.48–1.60; <20 yr, 1.32, 1.26–1.39), but lower among those who used ventilated than nonventilated cookstoves (1.22, 1.19–1.25 vs. 1.29, 1.24–1.35). For CLRD, COPD, and ALRI, the HRs associated with solid fuel use were 1.47 (1.41–1.52), 1.10 (1.03–1.18), and 1.16 (1.09–1.23), respectively. Conclusions: Among Chinese adults, solid fuel use for cooking was associated with higher risks of major respiratory disease admissions and death, and switching to clean fuels or use of ventilated cookstoves had lower risk than not switching.