切换室内燃料与身心认知多病共病的发生率：一项前瞻性队列研究。

Switching indoor fuels and the incidence of physical-psychological-cognitive multimorbidity: A prospective cohort study.

机构信息

Group of Chronic Disease and Environmental Genomics, School of Public Health, China Medical University, Shenyang, Liaoning 110122, China.

出版信息

Ecotoxicol Environ Saf. 2024 Sep 1;282:116719. doi: 10.1016/j.ecoenv.2024.116719. Epub 2024 Jul 13.

DOI:10.1016/j.ecoenv.2024.116719

PMID:39002375

Abstract

BACKGROUND

In developing countries, including China, solid-fuel-based heating and cooking is common. For older people, the multimorbidity prevalence is exceptionally high. Nevertheless, studies on the associations of indoor solid fuels use, especially switching fuels types, on multimorbidity in middle-aged and older people is scarce.

METHODS

Data from five waves of the China Health and Retirement Longitudinal Study were used in this study. Indoor fuels were classified as solid or clean fuels. Physical-psychological-cognitive multimorbidity (PPC-multimorbidity) was defined as the simultaneous presence of three disease types (physical illness, psychological disorders, cognitive impairment). Using Cox proportional risk models, hazard ratios (HRs) and 95 % confidence intervals (95 % CI) were calculated to investigate the associations of heating- and cooking-related baseline indoor fuels and switching indoor fuels with PPC-multimorbidity incidence.

RESULTS

In the heating (n=3121, mean age=56.55 years, male proportion=54.25 %) and cooking (n=3574, mean age=56.67 years, male proportion=52.94 %) analyses, 75.07 % and 45.64 % of the participants used solid fuels at baseline, and 564 (18.07 %) and 613 (17.15 %) PPC-multimorbidity cases were diagnosed during follow-up, respectively. Participants with baseline heating- and cooking-based solid fuels use had greater PPC-multimorbidity incidences [HRs (95 % CIs): 1.23 (0.98, 1.55) and 1.44 (1.21, 1.73)], respectively. Additionally, combined baseline heating- and cooking-based solid fuels use was associated with even greater PPC-multimorbidity incidence [HR (95 % CI): 1.55 (1.18, 2.04)]. Persistent solid fuels use obviously increased the PPC-multimorbidity incidence [HRs (95 % CIs): 2.43 (1.67, 3.55) for heating and 2.63 (2.03, 3.40) for cooking]. Moreover, switching from solid to clean fuels was associated with a significantly decreased PPC-multimorbidity incidence [HRs (95 % CIs): 0.27 (0.20, 0.35) for heating and 0.36 (0.28, 0.46) for cooking].

CONCLUSIONS

Long-term solid-fuels use is associated with an increased PPC-multimorbidity incidence, and switching to cleaner fuels is associated with a decreased PPC-multimorbidity incidence in adults aged ≥45 years.

摘要

背景

在包括中国在内的发展中国家，固体燃料的取暖和烹饪很常见。对于老年人来说，多种疾病的发病率异常高。然而，关于室内固体燃料使用，特别是燃料类型转换，与中年和老年人多种疾病之间关联的研究却很少。

方法

本研究使用了中国健康与退休纵向研究的五个波次的数据。室内燃料分为固体燃料或清洁燃料。身体-心理-认知多种疾病（PPC-多种疾病）定义为同时存在三种疾病类型（身体疾病、心理障碍、认知障碍）。使用 Cox 比例风险模型计算危险比（HR）和 95%置信区间（95%CI），以调查与取暖和烹饪相关的基础室内燃料和切换室内燃料与 PPC-多种疾病发病之间的关联。

结果

在取暖（n=3121，平均年龄 56.55 岁，男性比例 54.25%）和烹饪（n=3574，平均年龄 56.67 岁，男性比例 52.94%）分析中，75.07%和 45.64%的参与者在基线时使用固体燃料，分别有 564（18.07%）和 613（17.15%）例 PPC-多种疾病病例在随访期间被诊断。基线使用固体燃料取暖和烹饪的参与者具有更高的 PPC-多种疾病发病风险[HRs（95%CI）：1.23（0.98，1.55）和 1.44（1.21，1.73）]。此外，基线联合使用固体燃料取暖和烹饪与更高的 PPC-多种疾病发病风险相关[HR（95%CI）：1.55（1.18，2.04）]。持续使用固体燃料明显增加了 PPC-多种疾病的发病风险[HRs（95%CI）：取暖为 2.43（1.67，3.55），烹饪为 2.63（2.03，3.40）]。此外，从固体燃料转换为清洁燃料与 PPC-多种疾病发病风险显著降低相关[HRs（95%CI）：取暖为 0.27（0.20，0.35），烹饪为 0.36（0.28，0.46）]。