Journal
INTERNATIONAL JOURNAL OF EPIDEMIOLOGY
Volume 49, Issue 1, Pages 45-55Publisher
OXFORD UNIV PRESS
DOI: 10.1093/ije/dyz216
Keywords
Household air pollution; solid fuels; smoking; chronic liver disease; cohort study; China
Categories
Funding
- UK Medical Research Council: Global Challenges Research Fund - Foundation Award [MR/P025080/1]
- Nuffield Department of Population Health, University of Oxford
- Kadoorie Charitable Foundation in Hong Kong
- UK Wellcome Trust [202922/Z/16/Z, 104085/Z/14/Z, 088158/Z/09/Z]
- National Natural Science Foundation of China [918433302]
- National Key Research and Development Program of China [2016YFC0900500, 2016YFC0900501, 2016YFC0900504, 2016YFC1303904]
- British Heart Foundation
- UK Medical Research Council
- Cancer Research
- MRC [MR/P025080/1, MC_UU_12026/2, MC_U137686851, MC_UU_00017/1] Funding Source: UKRI
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Background: Harmful substances in solid fuel and tobacco smoke are believed to enter the bloodstream via inhalation and to be metabolized in the liver, leading to chronic liver damage. However, little is known about the independent and joint effects of solid fuel use and smoking on risks of chronic liver disease (CLD) mortality. Methods: During 2004-08, similar to 0.5 million adults aged 30-79 years were recruited from 10 areas across China. During a 10-year median follow-up, 2461 CLD deaths were recorded. Multivariable Cox regression yielded adjusted hazard ratios (HRs) and 95% confidence intervals (Cis) for the individual associations of self-reported long-term cooking fuel and tobacco use with major CLD death. Results: Overall, 49% reported solid fuel use and 26% smoked regularly. Long-term solid fuel use for cooking and current smoking were associated with higher risks of CLD deaths, with adjusted HRs of 1.26 (95% CI, 1.02-1.56) and 1.28 (1.13-1.44), respectively. Compared with never-smoking clean fuel users, the HRs were 1.41 (1.10-1.82) in neversmoking solid fuel users, 1.55 (1.17-2.06) in regular-smoking clean fuel users and 1.71 (1.32-2.20) in regular-smoking solid fuels users. Individuals who had switched from solid to clean fuels (1.07, 0.90-1.29; for median 14 years) and ex-regular smokers who stopped for non-medical reasons (1.16, 0.95-1.43; for median 10 years) had no evidence of excess risk of CLD deaths compared with clean fuel users and never-regular smokers, respectively. Conclusions: Among Chinese adults, long-term solid fuel use for cooking and smoking were each independently associated with higher risks of CLD deaths. Individuals who had stopped using solid fuels or smoking had lower risks.
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