1. Solid fuel use for cooking and heating was associated with increased risk of cardiovascular and all-cause mortality.
2. People who had previously switched from solid to clean fuels experienced a lower risk of cardiovascular and all-cause mortality than those who continued to use solid fuel.
Evidence Rating Level: 2 (Good)
Study Rundown: There is a heavy worldwide reliance on solid fuels, including wood, coal, and charcoal, and it is well-known that these fuels generate a great deal of pollutants, particularly fine particulate matter. For those who use these fuels to cook indoors, the risk of cardiovascular disease is suspected to be elevated. In this prospective cohort study, the use of solid fuels for cooking and for winter heating was associated with greater risk of cardiovascular mortality and all-cause mortality. People who had previously switched from solid to clean fuels, including gas, electricity, and central heating, had a lower risk of cardiovascular and all-cause mortality compared to those who were persistent solid fuel users. Solid fuel users who utilized ventilated cookstoves had decreased risk of cardiovascular and all-cause mortality.
Though the study strongly suggests significant harms from the use of solid fuels for cooking and heat, some limitations based on potential cofounders is noted. For instance, those who use solid fuels tend to be of lower socioeconomic status, which is independently tied to increased risk of cardiovascular and all-cause mortality. Further, this study was based on self-reported fuel use, partially as a proxy for household air pollution exposure, which can vary due to other factors not measured in the study.
Relevant Reading: Household fuel use and cardiovascular disease mortality
In-Depth [prospective cohort]: This study was a nationwide prospective cohort study from 2004-2008 of 271 217 adults from 5 rural areas in China who did not have a self-reported history of cardiovascular disease at baseline. Solid (wood, coal, charcoal) and clean (gas, electricity, central heating) fuel use was assessed for cooking and winter heating. Use of solid fuels for cooking was associated with greater risk of cardiovascular mortality (HR 1.20, CI95 1.02-1.41) and all-cause mortality (HR 1.11, CI95 1.03-1.20), as was use of use of solid fuels for heating [cardiovascular mortality (HR 1.29, CI95 1.06-1.55); all-cause mortality [HR 1.14, CI95 1.03-1.26)]. People who had previously switched from solid to clean fuels for cooking, compared to those who were persistent solid fuel users, had a lower risk of cardiovascular (HR 0.83, CI95 0.69-0.99) and all-cause mortality (HR 0.87, CI95 0.79-0.95). Finally, solid fuel users who utilized ventilated cookstoves had decreased risk of cardiovascular (HR 0.89, CI95 0.80-0.99) and all-cause mortality (HR 0.91, CI95 0.85-0.96).
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