Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, China.
Department of Pharmacology, School of Basic Medicine, Anhui Medical University, China.
Sci Total Environ. 2023 Feb 1;858(Pt 2):159829. doi: 10.1016/j.scitotenv.2022.159829. Epub 2022 Oct 29.
Frail individuals often face a high medical burden, and household solid fuel use is associated with a range of functional declines or diseases, but evidence on the relationship between household solid fuel and frailty and the resulting medical burden is limited. We aim to investigate the effect of household solid fuel on frailty and further quantify how much of the increased medical burden associated with frailty is attributable to household solid fuel.
The prospective data were from the China Health and Retirement Longitudinal Study, 4685 non-frail participants at baseline were included. Inverse probability weighting was used to balance the covariates between groups. The modified Poisson regression was used to analyze the association of household solid fuel (including baseline and switching across three-wave survey) with frailty, and the generalized linear model was used to analyze the association of frailty with the change in medical burden. Further, the increased medical burden associated with frailty attributable to household solid fuel was quantified.
Using solid fuel for cooking (RR = 1.29, 95%CI, 1.07-1.57), heating (RR = 1.38, 95%CI, 1.09-1.73), or both (RR = 1.40, 95%CI, 1.05-1.86) had a higher risk of frailty than using clean fuel. In addition, the risk of frailty generally increases with the times of solid fuel use across the three-wave survey. Then, frailty participants had a greater increase in the annual number of hospitalizations (β = 0.11, 95%CI, 0.02-0.19) and annual costs of hospitalizations (β = 2953.35, 95%CI, 1149.87-4756.83) than those non-frailty. Heating coal caused the largest frailty-related increase in the annual number of hospitalizations and annual costs of hospitalizations, with 0.04 and 1195.40, respectively.
The increased medical burden associated with frailty was partly attributable to household solid fuel, which suggested that intervention targeting household solid fuels can delay frailty and thus reduce individual medical burden.
虚弱个体通常面临较高的医疗负担，而家庭固体燃料的使用与一系列功能下降或疾病有关，但关于家庭固体燃料与虚弱的关系以及由此导致的医疗负担的证据有限。我们旨在研究家庭固体燃料对虚弱的影响，并进一步量化与虚弱相关的增加的医疗负担中有多少归因于家庭固体燃料。
前瞻性数据来自中国健康与退休纵向研究，共纳入 4685 名基线非虚弱参与者。使用逆概率加权法平衡组间协变量。采用修正泊松回归分析家庭固体燃料（包括基线和三波调查中的转换）与虚弱的关系，采用广义线性模型分析虚弱与医疗负担变化的关系。此外，量化了与家庭固体燃料相关的虚弱导致的增加的医疗负担。
使用固体燃料烹饪（RR=1.29，95%CI，1.07-1.57）、取暖（RR=1.38，95%CI，1.09-1.73）或两者（RR=1.40，95%CI，1.05-1.86）与使用清洁燃料相比，虚弱的风险更高。此外，随着三波调查中固体燃料使用次数的增加，虚弱的风险通常会增加。然后，虚弱参与者的年住院次数（β=0.11，95%CI，0.02-0.19）和年住院费用（β=2953.35，95%CI，1149.87-4756.83）增加幅度大于非虚弱参与者。取暖煤导致与虚弱相关的年住院次数和年住院费用增加幅度最大，分别为 0.04 和 1195.40。
与虚弱相关的增加的医疗负担部分归因于家庭固体燃料，这表明针对家庭固体燃料的干预措施可以延缓虚弱的发生，从而降低个体的医疗负担。
