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      Indoor air pollution from biomass fuel smoke is a major health concern in the developing world

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          Summary

          One-third of the world's population burn organic material such as wood, dung or charcoal (biomass fuel) for cooking, heating and lighting. This form of energy usage is associated with high levels of indoor air pollution and an increase in the incidence of respiratory infections, including pneumonia, tuberculosis and chronic obstructive pulmonary disease, low birthweight, cataracts, cardiovascular events and all-cause mortality both in adults and children. The mechanisms behind these associations are not fully understood. This review summarises the available information on biomass fuel use and health, highlighting the current gaps in knowledge.

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          Lung cancer, cardiopulmonary mortality, and long-term exposure to fine particulate air pollution.

          C. Arden Pope III (2002)
          Associations have been found between day-to-day particulate air pollution and increased risk of various adverse health outcomes, including cardiopulmonary mortality. However, studies of health effects of long-term particulate air pollution have been less conclusive. To assess the relationship between long-term exposure to fine particulate air pollution and all-cause, lung cancer, and cardiopulmonary mortality. Vital status and cause of death data were collected by the American Cancer Society as part of the Cancer Prevention II study, an ongoing prospective mortality study, which enrolled approximately 1.2 million adults in 1982. Participants completed a questionnaire detailing individual risk factor data (age, sex, race, weight, height, smoking history, education, marital status, diet, alcohol consumption, and occupational exposures). The risk factor data for approximately 500 000 adults were linked with air pollution data for metropolitan areas throughout the United States and combined with vital status and cause of death data through December 31, 1998. All-cause, lung cancer, and cardiopulmonary mortality. Fine particulate and sulfur oxide--related pollution were associated with all-cause, lung cancer, and cardiopulmonary mortality. Each 10-microg/m(3) elevation in fine particulate air pollution was associated with approximately a 4%, 6%, and 8% increased risk of all-cause, cardiopulmonary, and lung cancer mortality, respectively. Measures of coarse particle fraction and total suspended particles were not consistently associated with mortality. Long-term exposure to combustion-related fine particulate air pollution is an important environmental risk factor for cardiopulmonary and lung cancer mortality.
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            Particulate air pollution as a predictor of mortality in a prospective study of U.S. adults.

            C Pope, M Thun, M M Namboodiri … (1995)
            Time-series, cross-sectional, and prospective cohort studies have observed associations between mortality and particulate air pollution but have been limited by ecologic design or small number of subjects or study areas. The present study evaluates effects of particulate air pollution on mortality using data from a large cohort drawn from many study areas. We linked ambient air pollution data from 151 U.S. metropolitan areas in 1980 with individual risk factor on 552,138 adults who resided in these areas when enrolled in a prospective study in 1982. Deaths were ascertained through December, 1989. Exposure to sulfate and fine particulate air pollution, which is primarily from fossil fuel combustion, was estimated from national data bases. The relationships of air pollution to all-cause, lung cancer, and cardiopulmonary mortality was examined using multivariate analysis which controlled for smoking, education, and other risk factors. Although small compared with cigarette smoking, an association between mortality and particulate air pollution was observed. Adjusted relative risk ratios (and 95% confidence intervals) of all-cause mortality for the most polluted areas compared with the least polluted equaled 1.15 (1.09 to 1.22) and 1.17 (1.09 to 1.26) when using sulfate and fine particulate measures respectively. Particulate air pollution was associated with cardiopulmonary and lung cancer mortality but not with mortality due to other causes. Increased mortality is associated with sulfate and fine particulate air pollution at levels commonly found in U.S. cities. The increase in risk is not attributable to tobacco smoking, although other unmeasured correlates of pollution cannot be excluded with certainty.
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              An association between air pollution and mortality in six U.S. cities.

              Douglas Dockery, C. Pope, Xiping Xu … (1993)
              Recent studies have reported associations between particulate air pollution and daily mortality rates. Population-based, cross-sectional studies of metropolitan areas in the United States have also found associations between particulate air pollution and annual mortality rates, but these studies have been criticized, in part because they did not directly control for cigarette smoking and other health risks. In this prospective cohort study, we estimated the effects of air pollution on mortality, while controlling for individual risk factors. Survival analysis, including Cox proportional-hazards regression modeling, was conducted with data from a 14-to-16-year mortality follow-up of 8111 adults in six U.S. cities. Mortality rates were most strongly associated with cigarette smoking. After adjusting for smoking and other risk factors, we observed statistically significant and robust associations between air pollution and mortality. The adjusted mortality-rate ratio for the most polluted of the cities as compared with the least polluted was 1.26 (95 percent confidence interval, 1.08 to 1.47). Air pollution was positively associated with death from lung cancer and cardiopulmonary disease but not with death from other causes considered together. Mortality was most strongly associated with air pollution with fine particulates, including sulfates. Although the effects of other, unmeasured risk factors cannot be excluded with certainty, these results suggest that fine-particulate air pollution, or a more complex pollution mixture associated with fine particulate matter, contributes to excess mortality in certain U.S. cities.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Trans R Soc Trop Med Hyg
                Title: Transactions of the Royal Society of Tropical Medicine and Hygiene
                Publisher: Elsevier
                ISSN (Print): 0035-9203
                ISSN (Electronic): 1878-3503
                Publication date PMC-release: September 2008
                Publication date (Print): September 2008
                Volume: 102
                Issue: 9
                Pages: 843-851
                Affiliations
                [a ]Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
                [b ]Malawi-Liverpool-Wellcome Trust, Clinical Research Programme, PO Box 30096, Chichiri, Blantyre 3, Malawi
                [c ]Division of Public Health, University of Liverpool Whelan Building, Quadrangle, Liverpool L69 3GB, UK
                Author notes
                [* ]Corresponding author. Tel.: +44 151 705 3169; fax: +44 151 705 3370. duncan.fullerton@ 123456liverpool.ac.uk
                Article
                Publisher ID: TRSTMH940
                DOI: 10.1016/j.trstmh.2008.05.028
                PMC ID: 2568866
                PubMed ID: 18639310
                SO-VID: d0d0356a-ee17-4524-b9a1-3aca651d0d58
                Copyright © © 2008 Elsevier Ltd.
                License:

                This document may be redistributed and reused, subject to certain conditions.

                History
                Date received : 13 September 2007
                Date revision received : 28 May 2008
                Date accepted : 28 May 2008
                Categories
                Subject: Review

                ScienceOpen disciplines: Medicine
                Keywords: biomass fuel,respiratory tract infection,fuels,toxicity,hiv,chronic obstructive pulmonary disease
                Data availability:
                ScienceOpen disciplines: Medicine
                Keywords: biomass fuel, respiratory tract infection, fuels, toxicity, hiv, chronic obstructive pulmonary disease

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