Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing 210009, Jiangsu, China.
Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing 210009, Jiangsu, China.
Sci Total Environ. 2021 Jun 25;775:145518. doi: 10.1016/j.scitotenv.2021.145518. Epub 2021 Feb 2.
Both indoor unclean fuel use and CVD associates with cognitive function. Indoor fuel has transitioned from the use of unclean fuel to clean fuel in recent years in China. The aim of this study was to evaluate the association between adult cognitive function and such a transition and to investigate the potential role of CVD in this association. 7112 participants (26- to 98-years of age) with 12,676 observations living in twelve provinces of China from 1997 to 2015 were extracted based on having complete data. The associations, combined effects, and further mediation effects between indoor unclean fuel use and its transition, CVD, and cognitive function were tested using regression models, stratified analyses, the relative excess risk due to interaction (RERI), mediation analysis methods, and sensitivity analyses. Between 1997 and 2015, cooking fuel use coal and wood went down a lot in China, from a baseline of 26.9% to 6.1%, from 30.1% to 11.5%, respectively. Such a transition showed a positive association with delayed verbal recall (B = 0.288, p < 0.01), especially in rural area, subjects with age ≥ 65 years old, and women (all P < 0.05). The combined effect of the presence of hypertension during a baseline visit and such a transition on changes in delayed verbal recall was antagonistic (RERI = -0.529, p < 0.05). Moreover, the development of hypertension explained more than 50% of such a fuel transition-related decline of verbal memory. The transition of household energy to clean fuel was associated with a higher adult cognitive function. The presence or the development of CVD appeared to affect the association between indoor air pollution and cognitive function, which suggests a need to further optimize prevention of concurrent CVD and risk factor control in adults at higher risk for cognitive impairment and with indoor unclean cooking fuel, especially in potentially susceptible subgroups.
室内使用不清洁燃料以及心血管疾病都与认知功能有关。近年来，中国室内燃料已经从使用不清洁燃料向清洁燃料转变。本研究旨在评估成人认知功能与这种转变之间的关系，并探讨心血管疾病在这种关联中的潜在作用。基于完整的数据，从 1997 年至 2015 年，从中国十二个省份中提取了 7112 名参与者（年龄 26 至 98 岁），共有 12676 次观察。使用回归模型、分层分析、交互归因的超额相对风险（RERI）、中介分析方法和敏感性分析，测试了室内不清洁燃料的使用及其转变、心血管疾病和认知功能之间的关联、综合效应以及进一步的中介效应。1997 年至 2015 年期间，中国的烹饪燃料煤炭和木材的使用量大大减少，从基线的 26.9%下降到 6.1%，从 30.1%下降到 11.5%。这种转变与延迟言语回忆呈正相关（B=0.288，p<0.01），特别是在农村地区、年龄≥65 岁的人群和女性中（均 P<0.05）。在基线访视时存在高血压和这种转变对延迟言语回忆变化的综合影响呈拮抗作用（RERI=-0.529，p<0.05）。此外，高血压的发展解释了超过 50%的与这种燃料转变相关的言语记忆下降。家庭能源向清洁燃料的转变与成人更高的认知功能相关。心血管疾病的存在或发展似乎会影响室内空气污染与认知功能之间的关联，这表明需要进一步优化对认知障碍风险较高的成年人同时预防心血管疾病和控制危险因素，尤其是在潜在易感亚组中。
