Indoor biofuel air pollution and respiratory health: the role of confounding factors among women in highland Guatemala
Indoor biofuel air pollution and respiratory health: the role of confounding factors among women in highland Guatemala
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DOI：
10.1093/ije/27.3.454
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发表时间：
1998-06-01
影响因子：
7.7
通讯作者：
West, C
中科院分区：
文献类型：
--
作者：
Bruce, N;Neufeld, L;West, C
许多研究报告了发展中国家室内生物燃料空气污染与成人慢性阻塞性肺病（COLD）和儿童急性下呼吸道感染（ALRI）之间的关系。这些研究大多采用间接的暴露测量方法，通常没有充分处理混杂因素。关于这一假定影响的更可靠的量化信息是预防的一个重要先决条件，尤其是因为在世界上最贫穷的家庭中实现大幅减少接触的技术、经济和文化障碍，这些家庭的环境污染水平通常比建议的标准高出十到一百倍。这项研究是作为一项研究计划的一部分进行的，该计划旨在为能够提供健康效益量化估计的干预研究的发展提供信息。（“planchas”）和混杂因素的分布，在对340名年龄在15-45岁的妇女的横断面研究中进行了检查，生活在危地马拉西部高地的贫困农村地区。结果报告的咳嗽和痰的患病率显着较高的妇女使用明火的六个症状的措施。虽然这一发现与其他一些研究是一致的，但没有一项研究系统地研究了在这些环境中与混杂变量的强关联在多大程度上限制了观察性研究充分定义室内空气污染影响的能力。在火灾类型和一些家庭和社会经济因素之间发现了Vet-II强关联（P < 0.0001），包括房间的布置，地板类型和拥有收音机和电视机。配偶的经济活动类型也有显著性相关（P < 0.05）。因此，虽然82%的明火用户有泥土地板，只有18%的水泥或瓷砖地板，情况是相反的plancha的，只有16%的人有泥土floors.Conclusions混淆提出了一个实质性的问题，室内空气污染和健康的观察性研究，虽然有一个合理的情况下，相信所观察到的关联是因果关系。需要进行干预研究，以获得更有力的证据证明这种关联，更重要的是，确定通过可行的减少接触可获得的健康益处的大小。
Background A number of studies have reported associations between indoor biofuel air pollution in developing countries and chronic obstructive lung disease (COLD) in adults and acute lower respiratory infection (ALRI) in children. Most of these studies have used indirect measures of exposure and generally dealt inadequately with confounding. More reliable, quantified information about this presumed effect is an important pre-requisite for prevention, not least because of the technical, economic and cultural barriers to achieving substantial exposure reductions in the world's poorest households, where ambient pollution levels are typically between ten and a hundred times higher than recommended standards. This study was carried out as parr of a programme of research designed to inform the development of intervention studies capable of providing quantified estimates of health benefits.Methods The association between respiratory symptoms and the use of open fires and chimney woodstoves ('planchas'), and the distribution of confounding factors, were examined in a cross-sectional study of 340 women aged 15-45 years, living in a poor rural area in the western highlands of Guatemala.Results The prevalence of reported cough and phlegm was significantly higher for three of six symptom measures among women using open fires. Although this finding is consistent with a number of other studies, none has systematically examined the extent to which strong associations with confounding variables in these settings limit the ability of observational studies to define the effect of indoor air pollution adequately. Vet-II strong associations (P < 0.0001) were found between the type of fire and a number of household and socioeconomic factors including the arrangement of rooms, floor type, and possession of a radio and television. The spouse's economic activity type was also significantly associated (P < 0.05). Thus, while 82% of open fire users had dirt floors and only 18% cement or tile floors, the situation was reversed for plancha risers, only 16% of whom had dirt floors.Conclusions Confounding presents a substantial problem for observational studies of indoor air pollution and health, although there is a reasonable case for believing that the observed association is causal. Intervention studies are required for stronger evidence of this association, and more importantly, to determine the size of health benefit achievable through feasible exposure reductions.