title: Risk of lung cancer associated with domestic use of coal in Xuanwei, China: retrospective cohort study.
abstract: OBJECTIVE
  To estimate the risk of lung cancer associated with the use of different types of coal for household cooking and heating.
  
  
  METHODS
  Xuanwei County, Yunnan Province, China.
  
  
  METHODS
  Retrospective cohort study (follow-up 1976-96) comparing mortality from lung cancer between lifelong users of "smoky coal" (bituminous) and "smokeless coal" (anthracite).
  
  
  METHODS
  27,310 individuals using smoky coal and 9962 individuals using smokeless coal during their entire life.
  
  
  METHODS
  Primary outcomes were absolute and relative risk of death from lung cancer among users of different types of coal. Unadjusted survival analysis was used to estimate the absolute risk of lung cancer, while Cox regression models compared mortality hazards for lung cancer between smoky and smokeless coal users.
  
  
  RESULTS
  Lung cancer mortality was substantially higher among users of smoky coal than users of smokeless coal. The absolute risks of lung cancer death before 70 years of age for men and women using smoky coal were 18% and 20%, respectively, compared with less than 0.5% among smokeless coal users of both sexes. Lung cancer alone accounted for about 40% of all deaths before age 60 among individuals using smoky coal. Compared with smokeless coal, use of smoky coal was associated with an increased risk of lung cancer death (for men, hazard ratio 36 (95% confidence interval 20 to 65); for women, 99 (37 to 266)).
  
  
  CONCLUSIONS
  In Xuanwei, the domestic use of smoky coal is associated with a substantial increase in the absolute lifetime risk of developing lung cancer and is likely to represent one of the strongest effects of environmental pollution reported for cancer risk. Use of less carcinogenic types of coal could translate to a substantial reduction of lung cancer risk.
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, 6120 Executive Blv, EPS 8015, Bethesda, MD 20892-7240, USA. baroneadesif@mail.nih.gov
authors.forename: Francesco
authors.initials: F
authors.lastname: Barone-Adesi
authors.forename: Robert S
authors.initials: RS
authors.lastname: Chapman
authors.forename: Debra T
authors.initials: DT
authors.lastname: Silverman
authors.forename: Xinghzhou
authors.initials: X
authors.lastname: He
authors.forename: Wei
authors.initials: W
authors.lastname: Hu
authors.forename: Roel
authors.initials: R
authors.lastname: Vermeulen
authors.forename: Bofu
authors.initials: B
authors.lastname: Ning
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Fraumeni
authors.forename: Nathaniel
authors.initials: N
authors.lastname: Rothman
authors.forename: Qing
authors.initials: Q
authors.lastname: Lan
mesh_terms: D000368:Aged; D016902:Air Pollution, Indoor / Q000009:adverse effects* / Q000706:statistics & numerical data; D002423:Cause of Death; D002681:China / Q000453:epidemiology; D003031:Coal / Q000009:adverse effects* / Q000706:statistics & numerical data; D003296:Cooking / Q000379:methods; D005260:Female; D006361:Heating / Q000379:methods; D006801:Humans; D008175:Lung Neoplasms / Q000139:chemically induced / Q000453:epidemiology* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012424:Rural Population; D017678:Sex Distribution; D012906:Smoke / Q000009:adverse effects; D012907:Smoking / Q000453:epidemiology; D016019:Survival Analysis
chemical_list: D003031:Coal; D012906:Smoke