Association of Exposure to Biomass Fuels with Occurrence of Chronic Obstructive Pulmonary Disease in Rural Western China: A Real-World Nested Case-Control Study

Abstract

Xuan Zhang,1 Xia Zhu,2 Xiaoli Wang,3 Liping Wang,4 Hongying Sun,5 Ping Yuan,6 Yulin Ji1 1Department of Respiratory and Critical Care Medicine, Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, People’s Republic of China; 2Center of Infectious Disease, West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, People’s Republic of China; 3Department of Infectious disease Prevention and Control, Center for Disease Control and Prevention of Fucheng, Mianyang, Sichuan Province, 621000, People’s Republic of China; 4Department of Disease Control, Health Bureau of Jiangyou, Jiangyou, Sichuan Province, 621700, People’s Republic of China; 5Department of Tuberculosis Prevention and Control, Center for Disease Control and Prevention of Mianyang, Mianyang, Sichuan Province, 621000, People’s Republic of China; 6Department of Epidemiology and Statistics, West China School of Public Health, Sichuan University, Chengdu, Sichuan Province, 610041, People’s Republic of ChinaCorrespondence: Yulin Ji, Department of Respiratory and Critical Care Medicine, Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, 610041, People’s Republic of China, Tel [phone], Fax [phone], Email [email protected]: This study investigated the potential contribution of biomass fuels exposure to the occurrence of chronic obstructive pulmonary disease (COPD) in rural areas of western China.Methods: We analyzed data collected between October 2017 and October 2018 from a nested case-control study of individuals at least 40 years old in the general population in Mianyang City, Sichuan Province, China. Demographic information was collected using a custom-designed questionnaire, and lung function was measured using spirometry. We used multivariate logistic regression to explore the possible relationship between biomass fuels exposure and COPD, as well as between other potential risk factors and COPD. Bayes’ theorem was used to estimate weights for different COPD risk factors.Results: COPD was newly diagnosed in 500 of the 11398 adults surveyed, corresponding to an incidence of 4.39%. Individuals who were exposed to biomass fuels were at a significantly greater risk of developing COPD than those not exposed (OR 2.58, 95% CI 2.23– 3.05). In subgroup analysis, exposure to biomass fuels increased the risk of COPD in men by 1.71 times (95% CI 1.09– 2.68) and in women by 2.88 times (95% CI 2.01– 3.48), in never-smokers by 2.18 times. Bayesian weights for COPD risk factors were highest for poor kitchen ventilation (W=31.13%) and biomass fuels exposure (W=18.08%).Conclusion: Our data indicate that rural Chinese who are exposed to biomass fuels during cooking or heating are at greater risk of developing COPD. Efforts should be made to strengthen the construction of clean energy infrastructure, so as to reduce the use of biomass fuels and thereby help prevent COPD.Keywords: chronic obstructive pulmonary disease, biomass fuels, contribution to COPD, incidence, prevention

Keywords

• chronic obstructive pulmonary disease
• biomass fuels
• contribution to copd
• incidence
• prevention