title: Coal use, stove improvement, and adult pneumonia mortality in Xuanwei, China: a retrospective cohort study.
abstract: BACKGROUND
  In Xuanwei County, China, unvented indoor coal burning is strongly associated with increased risk of lung cancer and chronic obstructive pulmonary disease. However, the impact of coal burning and stove improvement on risk of pneumonia is not clear.
  
  
  METHODS
  We conducted a retrospective cohort study among all farmers born 1917 through 1951 and living in Xuanwei as of 1 January 1976. The analysis included a total of 42,422 cohort members. Follow-up identified all deaths in the cohort from 1976 through 1996. Ages at entry into and at exit from follow-up ranged from 24 to 59 years and from 25 to 80 years, respectively. The record search detected 225 deaths from pneumonia, and 32,332 (76%) were alive as of 31 December 1996. We constructed multivariable Cox models (time variable = age) to estimate hazard ratios (HRs) and 95% confidence intervals (CIs).
  
  
  RESULTS
  Use of coal, especially smokeless coal, was positively associated with pneumonia mortality. Annual tonnage and lifetime duration of smoky and smokeless coal use were positively associated with pneumonia mortality. Stove improvement was associated with a 50% reduction in pneumonia deaths (smoky coal users: HR, 0.521; 95% CI, 0.340-0.798; smokeless coal users: HR, 0.449; 95% CI, 0.215-0.937).
  
  
  CONCLUSIONS
  Our analysis is the first to suggest that indoor air pollution from unvented coal burning is an important risk factor for pneumonia death in adults and that improving ventilation by installing a chimney is an effective measure to decrease it.
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland 20892-7240 , USA. shenmi@mail.nih.gov
authors.forename: Min
authors.initials: M
authors.lastname: Shen
authors.forename: Robert S
authors.initials: RS
authors.lastname: Chapman
authors.forename: Roel
authors.initials: R
authors.lastname: Vermeulen
authors.forename: Linwei
authors.initials: L
authors.lastname: Tian
authors.forename: Tongzhang
authors.initials: T
authors.lastname: Zheng
authors.forename: Bingshu E
authors.initials: BE
authors.lastname: Chen
authors.forename: Eric A
authors.initials: EA
authors.lastname: Engels
authors.forename: Xingzhou
authors.initials: X
authors.lastname: He
authors.forename: Aaron
authors.initials: A
authors.lastname: Blair
authors.forename: Qing
authors.initials: Q
authors.lastname: Lan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002681:China / Q000453:epidemiology; D003031:Coal / Q000009:adverse effects*; D015331:Cohort Studies; D005260:Female; D006794:Household Articles; D006801:Humans; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000139:chemically induced / Q000453:epidemiology* / Q000401:mortality*; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D003031:Coal