Abstract：
BACKGROUND: In developing countries, including China, solid-fuel-based heating and cooking is common. For older people, the multimorbidity prevalence is exceptionally high. Nevertheless, studies on the associations of indoor solid fuels use, especially switching fuels types, on multimorbidity in middle-aged and older people is scarce.
METHODS: Data from five waves of the China Health and Retirement Longitudinal Study were used in this study. Indoor fuels were classified as solid or clean fuels. Physical-psychological-cognitive multimorbidity (PPC-multimorbidity) was defined as the simultaneous presence of three disease types (physical illness, psychological disorders, cognitive impairment). Using Cox proportional risk models, hazard ratios (HRs) and 95 % confidence intervals (95 % CI) were calculated to investigate the associations of heating- and cooking-related baseline indoor fuels and switching indoor fuels with PPC-multimorbidity incidence.
RESULTS: In the heating (n=3121, mean age=56.55 years, male proportion=54.25 %) and cooking (n=3574, mean age=56.67 years, male proportion=52.94 %) analyses, 75.07 % and 45.64 % of the participants used solid fuels at baseline, and 564 (18.07 %) and 613 (17.15 %) PPC-multimorbidity cases were diagnosed during follow-up, respectively. Participants with baseline heating- and cooking-based solid fuels use had greater PPC-multimorbidity incidences [HRs (95 % CIs): 1.23 (0.98, 1.55) and 1.44 (1.21, 1.73)], respectively. Additionally, combined baseline heating- and cooking-based solid fuels use was associated with even greater PPC-multimorbidity incidence [HR (95 % CI): 1.55 (1.18, 2.04)]. Persistent solid fuels use obviously increased the PPC-multimorbidity incidence [HRs (95 % CIs): 2.43 (1.67, 3.55) for heating and 2.63 (2.03, 3.40) for cooking]. Moreover, switching from solid to clean fuels was associated with a significantly decreased PPC-multimorbidity incidence [HRs (95 % CIs): 0.27 (0.20, 0.35) for heating and 0.36 (0.28, 0.46) for cooking].
CONCLUSIONS: Long-term solid-fuels use is associated with an increased PPC-multimorbidity incidence, and switching to cleaner fuels is associated with a decreased PPC-multimorbidity incidence in adults aged ≥45 years.
METHODS: Data from five waves of the China Health and Retirement Longitudinal Study were used in this study. Indoor fuels were classified as solid or clean fuels. Physical-psychological-cognitive multimorbidity (PPC-multimorbidity) was defined as the simultaneous presence of three disease types (physical illness, psychological disorders, cognitive impairment). Using Cox proportional risk models, hazard ratios (HRs) and 95 % confidence intervals (95 % CI) were calculated to investigate the associations of heating- and cooking-related baseline indoor fuels and switching indoor fuels with PPC-multimorbidity incidence.
RESULTS: In the heating (n=3121, mean age=56.55 years, male proportion=54.25 %) and cooking (n=3574, mean age=56.67 years, male proportion=52.94 %) analyses, 75.07 % and 45.64 % of the participants used solid fuels at baseline, and 564 (18.07 %) and 613 (17.15 %) PPC-multimorbidity cases were diagnosed during follow-up, respectively. Participants with baseline heating- and cooking-based solid fuels use had greater PPC-multimorbidity incidences [HRs (95 % CIs): 1.23 (0.98, 1.55) and 1.44 (1.21, 1.73)], respectively. Additionally, combined baseline heating- and cooking-based solid fuels use was associated with even greater PPC-multimorbidity incidence [HR (95 % CI): 1.55 (1.18, 2.04)]. Persistent solid fuels use obviously increased the PPC-multimorbidity incidence [HRs (95 % CIs): 2.43 (1.67, 3.55) for heating and 2.63 (2.03, 3.40) for cooking]. Moreover, switching from solid to clean fuels was associated with a significantly decreased PPC-multimorbidity incidence [HRs (95 % CIs): 0.27 (0.20, 0.35) for heating and 0.36 (0.28, 0.46) for cooking].
CONCLUSIONS: Long-term solid-fuels use is associated with an increased PPC-multimorbidity incidence, and switching to cleaner fuels is associated with a decreased PPC-multimorbidity incidence in adults aged ≥45 years.
摘要：
背景：在发展中国家，包括中国,基于固体燃料的加热和烹饪是常见的。对于老年人来说，多发病率异常高。然而，关于室内固体燃料使用关联的研究，特别是转换燃料类型，中老年人多发病很少。
方法：本研究使用中国健康与退休纵向研究的五波数据。室内燃料被分类为固体或清洁燃料。身体-心理-认知多症（PPC-multiorbidity）被定义为同时存在三种疾病类型（身体疾病，心理障碍,认知障碍)。使用Cox比例风险模型，我们计算了风险比(HR)和95%置信区间(95%CI),以调查加热和烹饪相关的基准室内燃料以及转换室内燃料与PPC多症发生率的相关性.
结果：在加热中（n=3121，平均年龄=56.55岁，男性比例=54.25%)和烹饪(n=3574，平均年龄=56.67岁，男性比例=52.94%)分析，75.07%和45.64%的参与者在基线时使用固体燃料，在随访期间诊断出564例（18.07%）和613例（17.15%）PPC多发病病例，分别。基线加热和烹饪固体燃料使用的参与者具有更大的PPC-多发病率[HR（95％CIs）：1.23（0.98，1.55）和1.44（1.21，1.73）]，分别。此外,基于加热和烹饪的固体燃料基线联合使用与更高的PPC-多发病率相关[HR(95%CI):1.55(1.18,2.04)].持续使用固体燃料明显增加了PPC-多浊度的发生率[HR（95％CIs）：加热为2.43（1.67，3.55），烹饪为2.63（2.03，3.40）]。此外，从固体燃料转换为清洁燃料与PPC-多发病率显著降低相关[HR(95%CI):加热0.27(0.20,0.35)和烹饪0.36(0.28,0.46)].
结论：长期使用固体燃料与PPC多发病率增加有关，在≥45岁的成年人中，改用更清洁的燃料与PPC多发病率降低有关。
方法：本研究使用中国健康与退休纵向研究的五波数据。室内燃料被分类为固体或清洁燃料。身体-心理-认知多症（PPC-multiorbidity）被定义为同时存在三种疾病类型（身体疾病，心理障碍,认知障碍)。使用Cox比例风险模型，我们计算了风险比(HR)和95%置信区间(95%CI),以调查加热和烹饪相关的基准室内燃料以及转换室内燃料与PPC多症发生率的相关性.
结果：在加热中（n=3121，平均年龄=56.55岁，男性比例=54.25%)和烹饪(n=3574，平均年龄=56.67岁，男性比例=52.94%)分析，75.07%和45.64%的参与者在基线时使用固体燃料，在随访期间诊断出564例（18.07%）和613例（17.15%）PPC多发病病例，分别。基线加热和烹饪固体燃料使用的参与者具有更大的PPC-多发病率[HR（95％CIs）：1.23（0.98，1.55）和1.44（1.21，1.73）]，分别。此外,基于加热和烹饪的固体燃料基线联合使用与更高的PPC-多发病率相关[HR(95%CI):1.55(1.18,2.04)].持续使用固体燃料明显增加了PPC-多浊度的发生率[HR（95％CIs）：加热为2.43（1.67，3.55），烹饪为2.63（2.03，3.40）]。此外，从固体燃料转换为清洁燃料与PPC-多发病率显著降低相关[HR(95%CI):加热0.27(0.20,0.35)和烹饪0.36(0.28,0.46)].
结论：长期使用固体燃料与PPC多发病率增加有关，在≥45岁的成年人中，改用更清洁的燃料与PPC多发病率降低有关。
