Overall and cause-specific mortality rates among men and women with high exposure to indoor air pollution from the use of smoky and smokeless coal: a cohort study in Xuanwei, China
Roel C H Vermeulen,
Ying Chen,
Wei Hu,
Jason Wong,
Lützen Portengen,
Wei Zheng,
Bryan A Bassig,
Qing Lan,
Yu-Tang Gao,
Xiao-Ou Shu,
Qiu-Yin Cai,
Yunchao Huang,
Gong Yang,
Debra Silverman,
Wei Jie Seow,
Dean Hosgood,
George Downward,
Teja Nagaradona,
Bofu Ning,
Nathan Appel,
Jihua Li,
Kaiyun Yang,
Lauren McCullough
Affiliations
Roel C H Vermeulen
Institute for Risk Assessment Sciences, Utrecht University, Utrecht, Netherlands
Ying Chen
The Third Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
Wei Hu
Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
Jason Wong
Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
Lützen Portengen
Institute for Risk Assessment Sciences, Utrecht University, Utrecht, Netherlands
Wei Zheng
Department of Medicine, Division of Epidemiology, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
Bryan A Bassig
Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
Qing Lan
Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
Yu-Tang Gao
Department of Epidemiology, Shanghai Cancer Institute, Shanghai, China
Xiao-Ou Shu
Department of Medicine, Division of Epidemiology, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
Qiu-Yin Cai
Department of Medicine, Division of Epidemiology, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
Yunchao Huang
The Third Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
Gong Yang
Department of Medicine, Division of Epidemiology, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
Debra Silverman
Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
Wei Jie Seow
Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
Dean Hosgood
Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
George Downward
Institute for Risk Assessment Sciences, Utrecht University, Utrecht, Netherlands
Teja Nagaradona
Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
Bofu Ning
Xuanwei Center for Disease Control and Prevention, Xuanwei, Yunnan, China
Nathan Appel
Information Management Services Inc, Rockville, Maryland, USA
Jihua Li
Qujing Center for Diseases Control and Prevention, Qujing, Yunnan, China
Kaiyun Yang
The Third Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
Lauren McCullough
Department of Epidemiology, Emory University, Atlanta, Georgia, USA
Objectives Never-smoking women in Xuanwei (XW), China, have some of the highest lung cancer rates in the country. This has been attributed to the combustion of smoky coal used for indoor cooking and heating. The aim of this study was to evaluate the spectrum of cause-specific mortality in this unique population, including among those who use smokeless coal, considered ‘cleaner’ coal in XW, as this has not been well-characterised.Design Cohort study.Setting XW, a rural region of China where residents routinely burn coal for indoor cooking and heating.Participants Age-adjusted, cause-specific mortality rates between 1976 and 2011 were calculated and compared among lifetime smoky and smokeless coal users in a cohort of 42 420 men and women from XW. Mortality rates for XW women were compared with those for a cohort of predominately never-smoking women in Shanghai.Results Mortality in smoky coal users was driven by cancer (41%), with lung cancer accounting for 88% of cancer deaths. In contrast, cardiovascular disease (CVD) accounted for 32% of deaths among smokeless coal users, with 7% of deaths from cancer. Total cancer mortality was four times higher among smoky coal users relative to smokeless coal users, particularly for lung cancer (standardised rate ratio (SRR)=17.6). Smokeless coal users had higher mortality rates of CVD (SRR=2.9) and pneumonia (SRR=2.5) compared with smoky coal users. These patterns were similar in men and women, even though XW women rarely smoked cigarettes. Women in XW, regardless of coal type used, had over a threefold higher rate of overall mortality, and most cause-specific outcomes were elevated compared with women in Shanghai.Conclusions Cause-specific mortality burden differs in XW based on the lifetime use of different coal types. These observations provide evidence that eliminating all coal use for indoor cooking and heating is an important next step in improving public health particularly in developing countries.
