School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
JMIR Public Health Surveill. 2023 Jul 26;9:e43914. doi: 10.2196/43914.
Indoor air pollution has been reported to have adverse effects on the eye; however, the health effects of exposure to cooking with solid fuels on visual impairment remain unclear in China.
We aimed to examine the association between cooking with solid fuels and visual impairment, including distance visual impairment (DVI) and near visual impairment (NVI).
Data were obtained from the China Health and Retirement Longitudinal Study, a nationwide survey of adults aged over 45 years who were enrolled in 2011 (Wave 1) and followed up in Wave 2 (2013), Wave 3 (2015), and Wave 4 (2018). We used Cox proportional hazards models to determine the association between solid fuels use and visual impairment. Additionally, the impact of switching cooking fuel types on vision function were examined through wave-specific data analysis (Wave 1 and Wave 4). Interaction and subgroup analyses were performed to explore the potential effect modifiers. Data were collected using the stratified multistage random sampling method and further analyzed using SPSS 27.0 and R 4.2.1 statistical software packages.
A total of 9559 middle-aged and older Chinese adults without visual impairment at baseline were included in the study, with 51.2% (n=4914) of the participants reporting that they cooked with solid fuels. During the follow-up period, 2644 (27.5%) and 3130 (32.6%) participants developed DVI and NVI, respectively. Compared with the clean fuel users, participants who cooked with solid fuels had a higher risk of DVI (hazards ratio [HR] 1.38, 95% CI 1.28-1.50) and NVI (HR 1.18, 95% CI 1.10-1.27). In addition, switching the cooking fuel type from clean to solid fuels was associated with an elevated risk of DVI (HR 1.51, 95% CI 1.15-1.98) and NVI (HR 1.39, 95% CI 1.06-1.82) compared to persistently using clean fuels during the follow-up period, although no protective effect of switching from solid to clean fuels on NVI was found (P=.52). In subgroup analysis, we found that cooking with solid fuels increased the risk of DVI in participants younger than 65 years (HR 1.41, 95% CI 1.28-1.55), men (HR 1.45, 95% CI 1.28-1.65), urban residents (HR 1.41, 95% CI 1.08-1.75), and smokers (HR 1.43, 95% CI 1.25-1.64). By contrast, negative effects of cooking with solid fuels on NVI were found in nonsmokers (HR 1.21, 95% CI 1.11-1.33) and urban residents (HR 1.20, 95% CI 1.10-1.37).
Cooking with solid fuels was associated with an increased risk of visual impairment among middle-aged and older Chinese adults. These findings indicate that promoting the utilization of clean fuels is conducive to reducing the burden of visual impairment for the public.
室内空气污染已被报道对眼睛有不良影响；然而，在中国，使用固体燃料烹饪对视力损害的健康影响仍不清楚。
我们旨在研究使用固体燃料与视力障碍（包括远视力障碍和近视力障碍）之间的关系。
数据来自中国健康与退休纵向研究，这是一项对年龄在 45 岁以上的成年人进行的全国性调查，他们于 2011 年（第 1 波）登记，并在第 2 波（2013 年）、第 3 波（2015 年）和第 4 波（2018 年）进行了随访。我们使用 Cox 比例风险模型来确定固体燃料使用与视力障碍之间的关联。此外，还通过特定波次的数据分析（第 1 波和第 4 波）来检查转换烹饪燃料类型对视力功能的影响。进行了交互和亚组分析，以探索潜在的效应修饰剂。数据是使用分层多阶段随机抽样方法收集的，并使用 SPSS 27.0 和 R 4.2.1 统计软件包进一步分析。
共有 9559 名没有基线视力障碍的中老年中国成年人被纳入研究，其中 51.2%（n=4914）的参与者报告使用固体燃料烹饪。在随访期间，分别有 2644（27.5%）和 3130（32.6%）名参与者出现远视力障碍和近视力障碍。与使用清洁燃料的参与者相比，使用固体燃料的参与者发生远视力障碍的风险更高（风险比[HR] 1.38，95%置信区间[CI] 1.28-1.50）和近视力障碍（HR 1.18，95% CI 1.10-1.27）。此外，与在随访期间持续使用清洁燃料相比，从清洁燃料转换为固体燃料与远视力障碍（HR 1.51，95% CI 1.15-1.98）和近视力障碍（HR 1.39，95% CI 1.06-1.82）的风险升高相关，尽管从固体燃料转换为清洁燃料对近视力障碍没有保护作用（P=.52）。在亚组分析中，我们发现，在 65 岁以下的参与者中，使用固体燃料会增加远视力障碍的风险（HR 1.41，95% CI 1.28-1.55）、男性（HR 1.45，95% CI 1.28-1.65）、城市居民（HR 1.41，95% CI 1.08-1.75）和吸烟者（HR 1.43，95% CI 1.25-1.64）。相比之下，在不吸烟者（HR 1.21，95% CI 1.11-1.33）和城市居民（HR 1.20，95% CI 1.10-1.37）中，使用固体燃料对近视力障碍的负面影响较小。
在中国中老年人群中，使用固体燃料与视力障碍风险增加有关。这些发现表明，推广使用清洁燃料有利于减轻公众的视力损害负担。
