Characterizing the spectrum of mortality in a cohort of people exposed to indoor air pollution in Xuanwei, China (1976-2011) Open Access

Nagaradona, Teja (Spring 2019)

Permanent URL: https://etd.library.emory.edu/concern/etds/7h149r06p?locale=en
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Abstract

Background:Xuanwei (XW) county in Yunnan Province, China has one of the highest lung cancer rates in the world, particularly among never-smoking women. This has been attributed to the combustion of smoky coal, used for cooking and heating in the household. However, the broader spectrum of cause-specific mortality in this unique population has not been well-characterized, including among those who use smokeless coal, which is perceived as a “safer alternative” coal type among many residents of XW. 

Methods: A cohort of 42,220 men and women living in XW were followed from 1976-2011. Two questionnaires, one at baseline (1992) and one at follow-up (2009) of non-deceased respondents, were administered to assess various demographic and lifestyle characteristics, including lifetime coal use. Cause-specific mortality rates through 2011 were calculated in lifetime users of smoky and smokeless coal. 

Results:The mortality rate of total cancer was four times higher among lifetime users of smoky coal (578 deaths /100,000 people) relative to lifetime smokeless coal users (138 deaths /100,000 people) in XW (RR=4.01, 95% CI= 3.40-4.80).  In contrast, lifetime smokeless coal users had higher mortality rates of CVD (615 deaths /100,000 people) relative to smoky coal users (323 deaths /100,000 people; RR=2.96, 95% CI= 2.70-3.24). Similar rates were observed when stratified by sex. Rates of total COPD (RR= 1.21, 95% CI=1.0-1.31) and lung cancer (RR=17.30, 95% CI=12.58-23.72) were higher among smoky compared to smokeless coal users, whereas pneumonia rates were higher among smokeless coal users (RR=2.29, 95% CI=1.75-2.99). 

Conclusion:Evidence from this study suggests that the cause-specific burden of mortality differs in XW based on the use of different coal types. These descriptive observations provide etiologic hypotheses that should be evaluated in future epidemiologic studies of coal use and mortality risk.

Table of Contents

Table of Contents:Background……………………………………………………………..1-3

Methods.………………………………………………………………………………………....4-5

Results…………………………………………………………………………………………....6-8

Discussion………………………………………………………………………………………9-10

Future Directions………………………………………………………………………………...11

Refrences……………………………………………………………………………………....12-13

Tables…………………………………………………………………………………………...14-16

·      Table 1…………………………………………………………………………………...........14

·      Table 2…………………………………………………………………………………...........15

·      Table 3…………………………………………………………………………………...........16

Figures………………………………………………………………………………………......17-19

·      Figure 1…………………………………………………………………………………..........17

·      Figure 2…………………………………………………………………………………..........18

·      Figure 3…………………………………………………………………………………..........19

Appendicies………………………………………………………………………………….....20-26

·      Supplemental Table 1………………………………………………………………….....…20

·      Supplemental Figure 1……………………………………………………………….....21-22

·      Supplemental Figure 2……………………………………………………………........23-24

·      Supplemental Figure 3………………………………………………………………….......25

·      Supplemental Figure 4………………………………………………………………….......26

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