Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, China; West China Biomedical Big Data Center, West China Hospital of Sichuan University, Chengdu, China; Med-X Center for Informatics, Sichuan University, Chengdu, China.
Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, China.
Sci Total Environ. 2023 Jan 10;855:158896. doi: 10.1016/j.scitotenv.2022.158896. Epub 2022 Sep 20.
The adverse health effects of household air pollution have been widely explored, but few studies have evaluated the effects of household air pollution on the risk of cardiometabolic multimorbidity (CMM), a pressing public health concern worldwide. Thus, we aimed to investigate whether exposure to household use of polluting fuels is associated with morbid CMM and, if so, whether a healthy lifestyle could mitigate this association.
In this prospective, nationwide representative cohort of the China Health and Retirement Longitudinal Study (CHARLS), participants free of CMM (defined as the coexistence of 2 or more of the following: heart disease, stroke, and diabetes or high blood sugar) were included in 2011-2012 and followed for CMM incidence until 2018. Household air pollution was measured as the use of solid fuels for cooking and heating. The healthy lifestyle score was determined by six factors, physical activity, smoking, body mass index, total cholesterol, blood glucose, and blood pressure, and categorized into three groups (unhealthy, 0-1 factors; intermediate, 2-4; and healthy, 5-6). Cox proportional hazards models investigated associations between household air pollution and incident CMM. The potential modifier effect of a healthy lifestyle score was tested through stratified analyses.
Among 7125 eligible participants, 239 incident cases of CMM were identified over a median follow-up of 7.0 years. After adjustment for potential confounders, the use of solid household fuels for heating was associated with more significant hazards of CMM (adjusted hazard ratio [HR] 1.71, 95 % confidence interval [CI] 1.28 to 2.28), while use for cooking (HR, 1.14; 95 % CI, 0.85 to 1.52) was not. Compared with participants in the unhealthy group, those in the healthy and intermediate groups had considerably lower CMM risk, with adjusted HRs (95 % CI) of 0.17 (0.09 to 0.31) and 0.39 (0.29 to 0.53), respectively, regardless of the household air pollution category. Importantly, when participants adhered to a healthy lifestyle, exposure to household air pollution was no longer significantly associated with a higher risk of CMM (adjusted HR 1.77, 95 % CI 0.51 to 6.12; P = 0.369).
Household usage of polluting fuels was significantly associated with a higher risk of CMM, and adherence to a healthy lifestyle may mitigate this adverse effect. From a broader perspective, our findings underscore the importance of public health policies and interventions targeting multiple exposures (air pollution, physical activity, smoking, etc.) in enhancing the prevention of detrimental cardiometabolic health effect.
家庭空气污染对健康的不良影响已得到广泛研究，但很少有研究评估家庭空气污染对心血管代谢性多种疾病（CMM）风险的影响，这是一个全球性的紧迫公共卫生问题。因此，我们旨在探讨暴露于家庭使用污染燃料是否与多种心血管代谢疾病相关，以及如果是这样，健康的生活方式是否可以减轻这种关联。
在这项前瞻性的、全国代表性的中国健康与退休纵向研究（CHARLS）中，纳入了在 2011-2012 年无 CMM（定义为同时存在以下两种或两种以上疾病：心脏病、中风和糖尿病或高血糖）的参与者，并随访至 2018 年，以记录 CMM 的发病情况。家庭空气污染的测量指标为烹饪和取暖用固体燃料的使用情况。健康生活方式评分由六个因素决定，包括体力活动、吸烟、体重指数、总胆固醇、血糖和血压，并分为三组（不健康：0-1 个因素；中等：2-4 个因素；健康：5-6 个因素）。Cox 比例风险模型调查了家庭空气污染与 CMM 发病之间的关联。通过分层分析测试了健康生活方式评分的潜在修饰效应。
在 7125 名符合条件的参与者中，中位随访 7.0 年后，有 239 例 CMM 发病。在调整了潜在混杂因素后，家庭使用固体燃料取暖与 CMM 发病的风险显著增加相关（调整后的危险比[HR]为 1.71，95%置信区间[CI]为 1.28 至 2.28），而烹饪用固体燃料（HR 为 1.14；95%CI 为 0.85 至 1.52）则不然。与不健康组的参与者相比，健康组和中等组的 CMM 风险显著降低，调整后的 HR（95%CI）分别为 0.17（0.09 至 0.31）和 0.39（0.29 至 0.53），无论家庭空气污染类别如何。重要的是，当参与者坚持健康的生活方式时，暴露于家庭空气污染与 CMM 发病风险的增加不再显著相关（调整后的 HR 为 1.77，95%CI 为 0.51 至 6.12；P = 0.369）。
家庭使用污染燃料与 CMM 发病风险显著相关，而坚持健康的生活方式可能减轻这种不良影响。从更广泛的角度来看，我们的发现强调了公共卫生政策和干预措施针对多种暴露因素（空气污染、体力活动、吸烟等）的重要性，以增强对心血管代谢不良健康影响的预防。
