Abstract 2184: Past use of coal for cooking is associated with all-cause mortality in the prospective Shanghai Women's Health Study
Authors: Kim Christopher , Shu Xiao-Ou , Hosgood H. Dean , Bassig Bryan A. , Seow Wei Jie , Xiang Yongbin , Ji Bu-Tian , Hu Wei , Chow Wong-Ho , Gao Yutang , Rothman Nathaniel , Lan Qing 
Published: May 2015

Abstract
Introduction: Indoor air pollution (IAP), mostly from coal burning, was responsible for approximately 3.5 million deaths from all-causes and over 100,000 disability-adjusted life years in 2010. The majority of studies conducted in the past have been retrospective, in rural and under developed populations with recent and high levels of exposure. We assessed the association between historic kitchen coal use and various causes of mortality in the prospective Shanghai Women's Health Study cohort.
Methods: A cohort of 73,363 women was followed through December 2009 with a combination of in-person surveys every 2-3 years and annual linkage to a vital statistics registry database where all causes of mortality was recorded. A total of 3808 deaths were identified during the follow-up period. Cox proportional hazards models were used to estimate risk of mortality associated with in-home coal use. Models were adjusted for smoking status, family income, environmental tobacco smoke, occupational history, shift work, BMI, hormone therapy, and parity.
Results: All-cause mortality was elevated 13% among ever coal users (Hazard Ratio (HR): 1.13; 95% CI: 1.04-1.23) compared to never-coal users. Coal use was most strongly associated with all-cause mortality among women who had more than 15 years of coal use (15-30 years: HR: 1.14; 95% CI: 1.02-1.26; &gt;30 years: HR: 1.15; 95% CI: 1.04-1.26). Women with 15-30 years of coal use had a 21% elevation of cancer mortality (95% CI: 1.04-1.42), but no elevation was observed in women with &gt;30 years of coal use (HR: 1.06; 95% CI: 0.91-1.24) compared to never-coal users. More than 30 years of coal use was associated with a 32% elevated risk of cardiovascular mortality (HR: 1.32; 95% CI: 1.11-1.57), and 62% elevated risk of myocardial infarction mortality (HR: 1.62; 95% CI: 1.01-2.63) compared to never-coal users. All-cause mortality was elevated in women who last lived in a coal burning home up to 20 years ago (&gt;0-10 years: HR: 1.16; 95% CI: 1.04-1.28; &gt;10-20 years: HR: 1.21; 95% CI: 1.09-1.35).
Discussion: This is the first study of mortality and in-home coal use in a prospective study after much of Shanghai transitioned into a developed and urban city. Evidence from this study suggests that previous coal use could be related to excess cardiovascular and cancer deaths among women in Shanghai.
Citation Format: Christopher Kim, Xiao-Ou Shu, H. Dean Hosgood, Bryan A. Bassig, Wei Jie Seow, Yongbin Xiang, Bu-Tian Ji, Wei Hu, Wong-Ho Chow, Yutang Gao, Nathaniel Rothman, Qing Lan. Past use of coal for cooking is associated with all-cause mortality in the prospective Shanghai Women's Health Study. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 2184. doi:10.1158/1538-7445.AM2014-2184