Associations between cooking fuels and hypertension prevalence in Chinese adults: A prospective cohort analysis focusing on fuel transitioning

• Published in: Environment international 2023-05, Vol.175, p.107953-107953, Article 107953
• Main Authors: Li, Xing, Duan, Chongyang, Chen, Qing, Xiao, Jianpeng, (Jim) Zhang, Junfeng
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Air Pollution, Indoor - analysis; China - epidemiology; Cohort; Cohort Studies; Cooking; Cooking fuels; East Asian People; Humans; Hypertension; Hypertension - epidemiology; Middle Aged; Prevalence; Prospective Studies; Young Adult
• ISSN: 0160-4120; 1873-6750
• DOI: 10.1016/j.envint.2023.107953

•No cohort studies have examined impact of cooking fuel transitions on hypertension.•Persistent use of polluting fuels was associated with increased hypertension risk.•The transition to clean fuels reversed hypertension risk from polluting fuels. Using polluting cooking fuels is a suggested risk factor for hypertension. Transitioning to clean cooking fuels has occurred widely in China in the past 30 years. This provides an opportunity to examine whether the transition could reduce hypertension risk and to ascertain the inconsistent literature on the relationship between cooking fuels and hypertension prevalence. Initiated in 1989, the China Health and Nutrition Survey (CHNS) enrolled participants from 12 provinces in China. By 2015, nine waves of follow-up have been conducted. Based on self-reported cooking fuels, participants were classified into persistent clean fuel users, persistent polluting fuel users and those who transitioned from polluting fuels to clean fuels. Hypertension was defined as having systolic blood pressure (SBP) ≥ 140 mmHg, diastolic blood pressure (DBP) ≥ 90 mmHg, or self-reported current use of antihypertension medication. Among 12,668 participants, 3963 (31.28%) were persistent polluting fuel users; 4299 (33.94%) transitioned to clean fuels; and 4406 (34.78%) were persistent clean fuel users. During the period of follow-up (7.8 ± 6.1 years), hypertension was diagnosed in 4428 participants. Compared to persistent clean fuel users, persistent polluting fuel users had a higher risk for hypertension (hazard ratio [HR] 1.69, 95%CI 1.55–1.85), while those transitioned to clean fuels did not. The effects were consistent by gender and urbanicity, respectively. The HRs for hypertension were 1.99 (95%CI 1.75–2.25), 1.55 (95%CI 1.32–1.81) and 1.36 (95%CI 1.13–1.65) among those persistent polluting fuel users aged 18–44, 45–59 and ≥60 years old, respectively. Transitioning from using polluting fuels to clean fuels prevented an increase in hypertension risk. The finding highlights the importance of promoting the fuel transition as a risk-reduction strategy for reducing the disease burden from hypertension.