Health Effects of Household Solid Fuel Use: Findings from 11 Countries within the Prospective Urban and Rural Epidemiology Study
The study evaluates the health impacts of household air pollution from solid fuel use for cooking across 11 countries, finding that solid fuel use is linked to increased risks of all-cause mortality, cardiovascular disease, and respiratory disease. With 41.8% of participants using solid fuels, the research highlights the need for cleaner cooking alternatives to mitigate health risks in developing regions.
College of Health researcher(s)
Abstract
Background
Household air pollution (HAP) from solid fuel use for cooking affects 2.5 billion individuals globally and may contribute substantially to disease burden. However, few prospective studies have assessed the impact of HAP on mortality and cardiorespiratory disease.
Objectives
Our goal was to evaluate associations between HAP and mortality, cardiovascular disease (CVD), and respiratory disease in the prospective urban and rural epidemiology (PURE) study.
Methods
We studied 91,350 adults 35–70 y of age from 467 urban and rural communities in 11 countries (Bangladesh, Brazil, Chile, China, Colombia, India, Pakistan, Philippines, South Africa, Tanzania, and Zimbabwe). After a median follow-up period of 9.1 y, we recorded 6,595 deaths, 5,472 incident cases of CVD (CVD death or nonfatal myocardial infarction, stroke, or heart failure), and 2,436 incident cases of respiratory disease (respiratory death or nonfatal chronic obstructive pulmonary disease, pulmonary tuberculosis, pneumonia, or lung cancer). We used Cox proportional hazards models adjusted for individual, household, and community-level characteristics to compare events for individuals living in households that used solid fuels for cooking to those using electricity or gas.
Results
We found that 41.8% of participants lived in households using solid fuels as their primary cooking fuel. Compared with electricity or gas, solid fuel use was associated with fully adjusted hazard ratios of 1.12 (95% CI: 1.04, 1.21) for all-cause mortality, 1.08 (95% CI: 0.99, 1.17) for fatal or nonfatal CVD, 1.14 (95% CI: 1.00, 1.30) for fatal or nonfatal respiratory disease, and 1.12 (95% CI: 1.06, 1.19) for mortality from any cause or the first incidence of a nonfatal cardiorespiratory outcome. Associations persisted in extensive sensitivity analyses, but small differences were observed across study regions and across individual and household characteristics.
Discussion
Use of solid fuels for cooking is a risk factor for mortality and cardiorespiratory disease. Continued efforts to replace solid fuels with cleaner alternatives are needed to reduce premature mortality and morbidity in developing countries.
FAQ: Household Air Pollution (HAP)
What is household air pollution (HAP)?
Household air pollution (HAP) results from using solid fuels such as wood, coal, dung, or crop residues for cooking and heating. The smoke generated from burning these materials releases harmful pollutants, particularly fine particulate matter (PM2.5), into the air inside homes.
What are the health effects of HAP?
Exposure to HAP, primarily through cooking with solid fuels, is linked to various health problems, including:
- Increased mortality: Studies indicate that people living in households using solid fuels for cooking have a higher risk of death from all causes, especially cardiorespiratory diseases.
- Cardiovascular disease: HAP is associated with both fatal and nonfatal cardiovascular events like stroke, heart attack, and heart failure.
- Respiratory diseases: HAP exposure is strongly linked to respiratory issues like chronic obstructive pulmonary disease (COPD), tuberculosis, pneumonia, and lung cancer.
How many people are affected by HAP?
Globally, an estimated 2.5 billion individuals are exposed to HAP, primarily in low- and middle-income countries (LMICs) where solid fuel use for cooking remains prevalent.
How does HAP compare to outdoor air pollution?
The concentrations of harmful pollutants like PM2.5 can be significantly higher indoors in homes using solid fuels for cooking compared to levels found in outdoor air, even in areas with significant outdoor air pollution.
Why are there limited prospective studies on HAP's health effects?
Conducting large-scale prospective studies on HAP is challenging due to several factors:
- Exposure assessment: Accurately measuring individual exposure to HAP over long periods is difficult.
- Confounding factors: Socioeconomic conditions and other risk factors are often intertwined with solid fuel use, making it challenging to isolate HAP's specific effects.
- Resource limitations: LMICs, where HAP is most prevalent, often have limited resources for extensive research studies.
How are researchers studying HAP?
Researchers are using various methods to study HAP, including:
- Cohort studies: Following large groups of people over time, tracking their fuel use and health outcomes.
- Air quality monitoring: Measuring indoor air pollution levels in homes using different fuel types.
- Exposure modeling: Developing models to estimate household air pollution levels based on various factors.
What interventions can reduce HAP exposure?
The most effective way to reduce HAP exposure is transitioning to cleaner cooking fuels, such as electricity or liquefied petroleum gas (LPG). Other interventions include:
- Improved cookstoves: Using cookstoves with better ventilation systems can reduce smoke emissions.
- Behavioral changes: Simple practices like opening windows while cooking can improve ventilation.
What are the public health implications of HAP?
HAP is a significant public health concern, especially in LMICs. Replacing solid fuels with cleaner alternatives is crucial to reduce premature deaths and illnesses related to air pollution.