Impact of an Indoor Stove Intervention on Indicators of Cardiorespiratory Health

大约有30亿人依靠固体燃料燃烧来满足基本的国内能源需求。许多家庭依靠传统的、效率低下和通风不良的室内炉灶来满足这些需求，这可能导致极高的室内空气污染浓度。改进炉灶设计有可能大大减少污染物排放和室内空气污染。然而，对改良炉灶的定量和纵向评估有限。据估计，生物质和煤烟造成的室内空气污染每年在全世界造成约160万人过早死亡，约占全球疾病负担的3%。这些估计数主要基于呼吸系统疾病的影响。很少有研究评估室内生物质燃烧对心血管的影响。鉴于生物质烟雾暴露在世界各地普遍存在，心血管疾病的发病率日益增加，需要进一步研究这种关系，以充分评估负担。我们最近完成了在尼加拉瓜半农村地区123户家庭的炉灶干预研究的数据收集。在这里，我们建议对以前收集的数据进行全面分析，并增加一个新的实验室分析储存的干血斑样本。我们的中心假设是，与使用传统炉灶相比，使用改进的炉灶将降低空气污染浓度并改善健康状况。为了评估这一假设，我们提出了3个具体目标：（1）测量尼加拉瓜队列中基线和第2年从初级女性厨师收集的干血斑样本中的炎症标志物;（2）评估与采用改良炉灶有关的因素，然后根据健康指标的变化，审查改良炉灶的使用情况（炎症标志物、心率、血压、肺功能和症状）;（3）比较基线和第二年室内细颗粒物和室内及个人一氧化碳的空气污染浓度（在人口的子样本中），并评估污染浓度变化与健康结果变化的关系。心血管疾病在发展中国家是一种不断增长和研究不足的疾病，是尼加拉瓜的主要死亡原因。该项目不仅有助于了解炉灶使用与心血管疾病指标之间的关系，而且干血斑法的这种新用途还可以证明该方法在发展中国家测量心血管疾病风险亚临床标志物的可行性和实用性。证据支持室内污染物和心血管健康指标之间的关联可能会大大增加以前估计的疾病负担，由于炉灶烟雾。此外，对改进的炉灶干预措施以及与改进炉灶采用有关的因素进行纵向评估，对于鼓励和证明类似的干预措施和炉灶更换计划是必要的，特别是在世界上生物质是首选或必要的烹饪燃料的部分地区。 公共卫生相关性：大约30亿人依靠固体燃料燃烧来满足基本的国内能源需求。生物质燃烧造成的室内空气污染每年造成全球约160万人过早死亡，约占全球疾病负担的3%。拟议的工作将审查改进的室内炉灶干预措施对发展中国家呼吸和心血管健康指标的影响。

DESCRIPTION (provided by applicant): Approximately 3 billion people rely on solid fuel combustion to meet basic domestic energy needs. Many households rely on traditional, inefficient and poorly vented indoor cook stoves to meet these needs, which can result in extremely high indoor air pollution concentrations. Improved stove designs have the potential to substantially reduce pollutant emissions and indoor air pollution exposures. However, quantitative and longitudinal assessments of improved stoves are limited. Indoor air pollution from biomass and coal smoke is estimated to account for approximately 1.6 million premature deaths per year worldwide, representing about 3% of the global disease burden. These estimates are based primarily on respiratory disease effects. Very few studies have evaluated the cardiovascular effects of indoor biomass burning. Given the ubiquity of biomass smoke exposures around the world and the increasing prevalence of cardiovascular disease, further study of this relationship is needed in order to fully assess the burden. We recently completed data collection for a cook stove intervention study in 123 households in a semi-rural area of Nicaragua. Here we propose to conduct a comprehensive analysis of the previously collected data, and add a new laboratory analysis of stored dried blood spot samples. Our central hypothesis is that use of the improved stoves will result in lower air pollution concentrations and improved health status compared to the use of a traditional stove. To evaluate this hypothesis, we propose 3 Specific Aims: (1) Measure markers of inflammation in dried blood spot samples collected from primary female cooks at baseline and in Year 2 in the Nicaragua cohort; (2) Evaluate factors related to adoption of the improved stove, and then examine improved stove use in relation to changes in health indicators (inflammatory markers, heart rate, blood pressure, lung function, and symptoms); (3) Compare air pollution concentrations of indoor fine particulate matter and indoor and personal carbon monoxide at baseline and Year 2 (among a subsample of the population), and evaluate the relationship of change in pollution concentrations with change in health outcomes. Cardiovascular disease is a growing and under studied disease in developing countries, and it is the leading cause of death in Nicaragua. This project will contribute not only to the knowledge of the relationship between cook stove use and indicators of cardiovascular disease, but this novel use of the dried blood spot method can also demonstrate the feasibility and utility of the method for measuring sub-clinical markers of cardiovascular disease risk in developing countries. Evidence supporting associations between indoor pollutants and indicators of cardiovascular health could substantially increase the previously estimated burden of disease due to cook stove smoke. Furthermore, longitudinal evaluations of improved cook stove interventions, and factors related to improved stove adoptions, are necessary to encourage and justify similar intervention and stove change-out programs, especially in parts of the world where biomass is the preferred or necessary cooking fuel. PUBLIC HEALTH RELEVANCE: Approximately 3 billion people rely on solid fuel combustion to meet basic domestic energy needs. Indoor air pollution from biomass burning accounts for approximately 1.6 million premature deaths per year worldwide, representing about 3% of the global disease burden. The proposed work will examine the impact of an improved indoor cook stove intervention on indicators of respiratory and cardiovascular health in a developing country.