title: Incense use and cardiovascular mortality among Chinese in Singapore: the Singapore Chinese Health Study.
abstract: BACKGROUND
  Incense burning is common in many parts of the world. Although it is perceived that particulate matter from incense smoke is deleterious to health, there is no epidemiologic evidence linking domestic exposure to cardiovascular mortality.
  
  
  OBJECTIVE
  We examined the association between exposure to incense burning and cardiovascular mortality in the Singapore Chinese Health Study.
  
  
  METHODS
  We enrolled a total of 63,257 Singapore Chinese 45-74 years of age during 1993-1998. All participants were interviewed in person to collect information about lifestyle behaviors, including the practice of burning incense at home. We identified cardiovascular deaths via record linkage with the nationwide death registry through 31 December 2011.
  
  
  RESULTS
  In this cohort, 76.9% were current incense users, and most of the current users (89.9%) had burned incense daily for ≥ 20 years. Relative to noncurrent users, current users had a 12% higher risk of cardiovascular mortality [multivariable adjusted hazard ratio (HR) = 1.12; 95% CI: 1.04, 1.20]. The HR was 1.19 (95% CI: 1.03, 1.37) for mortality due to stroke and 1.10 (95% CI: 1.00, 1.21) for mortality due to coronary heart disease. The association between current incense use and cardiovascular mortality appeared to be limited to participants without a history of cardiovascular disease at baseline (HR = 1.16; 95% CI: 1.07, 1.26) but not linked to those with a history (HR = 1.00; 95% CI: 0.86, 1.17). In addition, the association was stronger in never-smokers (HR = 1.12; 95% CI: 1.02, 1.23) and former smokers (HR = 1.19; 95% CI: 1.00, 1.42) than in current smokers (HR = 1.05; 95% CI: 0.91, 1.22).
  
  
  CONCLUSIONS
  Long-term exposure to incense burning in the home environment was associated with an increased risk of cardiovascular mortality in the study population.
authors.affiliation: Saw Swee Hock School of Public Health, and.
authors.forename: An
authors.initials: A
authors.lastname: Pan
authors.forename: Maggie L
authors.initials: ML
authors.lastname: Clark
authors.forename: Li-Wei
authors.initials: LW
authors.lastname: Ang
authors.forename: Mimi C
authors.initials: MC
authors.lastname: Yu
authors.forename: Jian-Min
authors.initials: JM
authors.lastname: Yuan
authors.forename: Woon-Puay
authors.initials: WP
authors.lastname: Koh
mesh_terms: D000368:Aged; D000393:Air Pollutants / Q000009:adverse effects*; D016902:Air Pollution, Indoor / Q000009:adverse effects; D044466:Asian People; D003324:Coronary Artery Disease / Q000139:chemically induced / Q000401:mortality*; D003466:Cultural Characteristics; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012846:Singapore / Q000453:epidemiology
chemical_list: D000393:Air Pollutants