School of Public Health and the Second Affiliated Hospital, The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
School of Public Affairs, Zhejiang University, Hangzhou, Zhejiang, China.
Sci Total Environ. 2023 Apr 15;869:161654. doi: 10.1016/j.scitotenv.2023.161654. Epub 2023 Jan 23.
The decision for household cooking fuel choice is a complex and multi-dimensional process. This study aims to: 1) examine the trend of cooking fuel types during past decades; and 2) examine the association between switching from polluting to clean fuels for cooking and mortality risk.
This analysis included data on 39,359 participants from 9 waves of the China Health and Nutrition Survey (CHNS) (1991-2015). Participants with consistent polluting fuel use and with the polluting-to-clean transition were identified. Generalized estimating equations were used to examine the trend of clean fuel use from 1991 to 2015. Propensity score matching was used to address the data imbalance and confounding factors and Cox proportional hazards models were used to estimate the association.
We found an increasing trend of clean fuel use after adjusting for potential confounders in the full sample (OR = 56.89, 95 % CI: 48.17, 67.19), which appeared to be more pronounced for those in rural areas and with low socioeconomic status. Switching from polluting to clean fuels was associated with a 75 % lower risk of mortality (HR = 0.25, 95 % CI: 0.11, 0.54). These associations became more pronounced during the lag period from 9 to 15 years.
The transition from polluting to clean cooking fuels reduced excess deaths in China, particularly over a long period. Our findings support the increasing implementation of clean fuels and call for more efforts to improve its universal service, especially in rural and low socioeconomic status areas, to minimize health inequality.
家庭烹饪燃料选择是一个复杂且多维度的过程。本研究旨在：1）考察过去几十年烹饪燃料类型的变化趋势；2）考察从污染燃料向清洁燃料转换与死亡率风险之间的关系。
本分析纳入了来自中国健康与营养调查（CHNS）9 个波次（1991-2015 年）的 39359 名参与者的数据。确定了持续使用污染燃料且发生了由污染燃料向清洁燃料转换的参与者。采用广义估计方程考察了 1991 年至 2015 年清洁燃料使用率的变化趋势。采用倾向评分匹配法解决数据不平衡和混杂因素，采用 Cox 比例风险模型估计关联。
在调整了全样本中潜在混杂因素后，我们发现清洁燃料使用率呈上升趋势（OR=56.89，95%CI：48.17，67.19），在农村地区和社会经济地位较低的人群中，这一趋势更为明显。从污染燃料向清洁燃料转换与死亡率降低 75%相关（HR=0.25，95%CI：0.11，0.54）。这种关联在 9-15 年的滞后期间变得更为明显。
从污染燃料向清洁烹饪燃料的转变降低了中国的超额死亡人数，特别是在较长时期内。我们的研究结果支持加强清洁燃料的推广，并呼吁做出更多努力改善其普遍服务，特别是在农村地区和社会经济地位较低的地区，以尽量减少健康不平等。
