Cooking Coal Use and All-Cause and Cause-Specific Mortality in a Prospective Cohort Study of Women in Shanghai, China.
Nearly 4.3 million deaths worldwide were attributable to exposure to household air pollution in 2012. However, household coal use remains widespread.



We investigated the association of cooking coal and all-cause and cause-specific mortality in a prospective cohort of primarily never-smoking women in Shanghai, China.



A cohort of 74,941 women were followed from 1996 through 2009 with annual linkage to the Shanghai vital statistics database. Cause-specific mortality was identified through 2009. Use of household coal for cooking was assessed through a residential history questionnaire. Cox proportional hazards models estimated the risk of mortality associated with household coal use.



In this cohort, 63% of the women ever used coal (n = 46,287). Compared with never coal use, ever use of coal was associated with mortality from all causes [hazard ratio (HR) = 1.12; 95% confidence interval (CI): 1.05, 1.21], cancer (HR = 1.14; 95% CI: 1.03, 1.27), and ischemic heart disease (overall HR = 1.61; 95% CI: 1.14, 2.27; HR for myocardial infarction specifically = 1.80; 95% CI: 1.16, 2.79). The risk of cardiovascular mortality increased with increasing duration of coal use, compared with the risk in never users. The association between coal use and ischemic heart disease mortality diminished with increasing years since cessation of coal use.



Evidence from this study suggests that past use of coal among women in Shanghai is associated with excess all-cause mortality, and from cardiovascular diseases in particular. The decreasing association with cardiovascular mortality as the time since last use of coal increased emphasizes the importance of reducing use of household coal where use is still widespread.



Kim C, Seow WJ, Shu XO, Bassig BA, Rothman N, Chen BE, Xiang YB, Hosgood HD III, Ji BT, Hu W, Wen C, Chow WH, Cai Q, Yang G, Gao YT, Zheng W, Lan Q. 2016. Cooking coal use and all-cause and cause-specific mortality in a prospective cohort study of women in Shanghai, China. Environ Health Perspect 124:1384-1389; http://dx.doi.org/10.1289/EHP236.
Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Rockville, Maryland, USA.
Christopher
C
Kim
Wei Jie
WJ
Seow
Xiao-Ou
XO
Shu
Bryan A
BA
Bassig
Nathaniel
N
Rothman
Bingshu E
BE
Chen
Yong-Bing
YB
Xiang
H Dean
HD
Hosgood
Bu-Tian
BT
Ji
Wei
W
Hu
Cuiju
C
Wen
Wong-Ho
WH
Chow
Qiuyin
Q
Cai
Gong
G
Yang
Yu-Tang
YT
Gao
Wei
W
Zheng
Qing
Q
Lan
D000328:Adult; D000368:Aged; D016902:Air Pollution, Indoor / Q000009:adverse effects*; D002318:Cardiovascular Diseases / Q000139:chemically induced / Q000401:mortality*; D002423:Cause of Death; D002681:China / Q000453:epidemiology; D002947:Cities; D003031:Coal / Q000009:adverse effects*; D003296:Cooking; D005260:Female; D006801:Humans; D008875:Middle Aged; D009026:Mortality; D011446:Prospective Studies; D012306:Risk
D003031:Coal