Use of Solid Fuels for Heating, Cooking in China Associated With Increased Risk of Death

Bottom Line: Use of coal, wood or charcoal for cooking and heating in rural China was associated with a greater risk of death, with that risk decreased by having switched to gas, electricity or central heating, or using ventilation.

Why The Research Is Interesting: Worldwide, it has been estimated that more than 2.7 billion individuals were using solid fuels for domestic purposes in 2015, mostly in low- and middle-income countries including China, where an estimated 450 million people still heavily rely on solid fuels, such as wood, charcoal and coal. When combusted indoors, solid fuels generate a large amount of pollutants such as fine particulate matter.

Who and When: 271,217 adults without cardiovascular disease at study entry were recruited from five rural areas across China between June 2004 and July 2008; mortality follow-up was until January 2014. A random subset (10,892) participated in a resurvey after an average interval of 2.7 years.

What (Study Measures): Self-reported cooking and heating fuels (solid: coal, wood, or charcoal; clean: gas, electricity, or central heating), switching of fuel type before study entry, and use of ventilated cookstoves (exposures); death from cardiovascular and all causes (outcomes)

How (Study Design): This was an observational study. Researchers were not intervening for purposes of the study and cannot control all the natural differences that could explain the study findings.

Authors: Tangchun Wu, M.D., Ph.D., Huazhong University of Science and Technology, Wuhan, China; Liming Li, M.D., M.P.H., Peking University, Beijing, China, and coauthors


Study Limitations: Self-reported fuel use was used as a measure for household air pollution exposure, which could vary by level and efficiency of ventilation, climate, and fuel properties.

Study Conclusions:


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(doi:10.1001/jama.2018. 2151)