The Third Central Hospital of Tianjin, 83 Jintang Road, Hedong District, Tianjin 300170, China; Tianjin Key Laboratory of Extracorporeal Life Support for Critical Disease, China.
Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China.
Environ Int. 2021 Jan;146:106251. doi: 10.1016/j.envint.2020.106251. Epub 2020 Nov 25.
To date, few studies have focused on the influence of indoor air pollution on cognitive impairment. Thus, we aimed to explore the association of household fuel use, the major cause of household air pollution, with cognitive functioning among a sample of middle-aged and older Chinese individuals.
A total of 10,372 and 8,397 participants from the China Health and Retirement Longitudinal Study (CHARLS) were enrolled in the cross-sectional and follow-up analyses, respectively. Cognitive functioning was evaluated via a structured questionnaire in three dimensions: orientation and attention, episodic memory, and visuo-construction. The associations between household solid fuel use (for cooking and heating) and cognitive functioning were elucidated by generalized linear models. Furthermore, we explored the combined effect of solid fuel use in cooking and heating and examined the effects of switching cooking fuel types on a 4-year change in cognitive functioning.
In the cross-sectional study, solid fuel use for cooking or heating, separately or simultaneously, was positively associated with cognitive impairment, after adjusting for potential confounders. Similarly, in the follow-up study, solid cooking fuel use was associated with a greater decline in cognitive score overall (β = -0.24, 95% confidence interval [CI]: -0.45, -0.04), mostly in the episodic memory (β = -0.19, 95% CI: -0.34, -0.03) and visuo-construction (β = -0.03, 95% CI: -0.05, -0.01) dimensions; solid heating fuel use was associated only with a greater decrease in the orientation and attention dimension (β = -0.13, 95% CI: -0.25, -0.01). A combined effect of household fuel use was also observed (P < 0.05). Moreover, subjects who switched from solid to cleaner cooking fuel displayed a significantly lower degree of cognitive decline for all dimensions than did persistent solid fuel users over a 4-year period (P < 0.05).
Our findings show that household solid fuel use is a risk factor for the development of cognitive impairment. Improving the structure of cooking fuel may therefore have great public health value for the prevention of cognitive impairment.
迄今为止，很少有研究关注室内空气污染对认知障碍的影响。因此，我们旨在探讨家庭燃料使用（主要的室内空气污染原因）与中国中年及以上人群认知功能之间的关系。
共有 10372 名和 8397 名来自中国健康与退休纵向研究（CHARLS）的参与者分别纳入了横断面和随访分析。认知功能通过结构问卷在三个维度进行评估：定向和注意力、情景记忆和视觉构建。使用广义线性模型阐明家庭固体燃料（用于烹饪和取暖）使用与认知功能之间的关系。此外，我们还探讨了固体燃料在烹饪和取暖中的联合作用，并研究了在 4 年内改变烹饪燃料类型对认知功能变化的影响。
在横断面研究中，分别或同时使用固体燃料烹饪或取暖与认知障碍呈正相关，调整了潜在混杂因素后依然如此。同样，在随访研究中，固体烹饪燃料的使用与认知评分的总体下降有关（β=-0.24，95%置信区间[CI]：-0.45，-0.04），主要影响情景记忆（β=-0.19，95%CI：-0.34，-0.03）和视觉构建（β=-0.03，95%CI：-0.05，-0.01）维度；固体取暖燃料的使用仅与定向和注意力维度的下降有关（β=-0.13，95%CI：-0.25，-0.01）。还观察到家庭燃料使用的综合效应（P<0.05）。此外，与持续使用固体燃料的患者相比，在 4 年内改用更清洁的烹饪燃料的患者在所有维度上的认知下降程度明显较低（P<0.05）。
我们的研究结果表明，家庭固体燃料的使用是认知障碍发展的危险因素。因此，改善烹饪燃料结构对于预防认知障碍具有重要的公共卫生价值。
