生物质和固体燃料燃烧造成的室内空气污染对印度成人男性和女性自我主诉的哮喘患病率的影响：来自国家性大规
2012/05/08
目的：近几十年来，发展中国家哮喘的患病率呈现逐渐增加的趋势，这对公共卫生提出了更大的挑战。一些研究显示，环境的空气污染能触发哮喘发作。生物质和固体燃料是主要的室内空气污染来源，但在发展中国家，室内空气污染对健康的影响了解较少。本研究中，我们对用于烹调的生物质和固体燃料产生的烟雾对印度男性和女性哮喘患病的影响进行研究。
方法：本研究入选的99574名女性和56742名男性（年龄为20～49岁）来自于2005～2006年印度第三次国家家庭健康调查。炊烟对报道的哮喘发病率的影响采用多变量logistic回归分析进行评价。炊烟通过使用的燃料（生物质和固体燃料及清洁燃料）类型进行确定。由于炊烟可能受到烟草烟雾、年龄和其他因素的影响，因此在对上述混杂因素控制后进行分析。
结果：结果显示，使用生物质和固体燃料烹调的家庭妇女，即使在对混杂因素进行控制后，哮喘发病风险显著高于采用清洁燃料的女性（OR: 1.26; 95%CI: 1.06-1.49; p=0.010）。有意思的是，该想象未见于男性（OR: 0.98; 95%CI: 0.77-1.24; p=0.846）。然而，烟草烟雾与男性（OR: 1.35; 95%CI: 1.49-2.25; p<0.0001）和女性（OR: 1.72; 95%CI: 1.34-2.21; p<0.0001）的哮喘发病率相关。生物质和固体燃料的使用和烟草烟雾对哮喘的合并影响，在女性中更明显（女性：OR: 2.16; 95%CI: 1.58-2.94; p<0.0001；男性：OR: 1.34; 95%CI: 1.04-1.72; p=0.024）
结论：我们结果对诸如印度这样的发展中国家制定相关政策具有借鉴作用，这些国家大部分人群仍然依赖于使用生物质燃料进行烹调和取暖。减少室内生物质和固体燃料的使用，改善炉灶的工艺，有可能降低室内空气污染对健康的影响。有必要进行更多的流行病学研究，采用更高级的手段检测烟雾暴露和临床哮喘，以验证本文的结论。
（陈欣 审校）
J Asthma. 2012 Mar 7. [Epub ahead of print]
Effect of Indoor Air Pollution from Biomass and Solid Fuel Combustion on Prevalence of Self-Reported Asthma among Adult Men and Women in India: Findings from a Nationwide Large-Scale Cross-Sectional Survey.
Agrawal S.
Source
South Asia Network for Chronic Disease, Public Health Foundation of India , New Delhi , India.
Abstract
OBJECTIVES：Increasing prevalence of asthma in developing countries has been a significant challenge for public health in recent decades. A number of studies have suggested that ambient air pollution can trigger asthma attacks. Biomass and solid fuels are a major source of indoor air pollution, but in developing countries the health effects of indoor air pollution are poorly understood. In this study we examined the effect of cooking smoke produced by biomass and solid fuel combustion on the reported prevalence of asthma among adult men and women in India.
METHODS：The analysis is based on 99,574 women and 56,742 men aged between 20 and 49 years included in India’s third National Family Health Survey conducted in 2005-2006. Effects of exposure to cooking smoke, determined by the type of fuel used for cooking such as biomass and solid fuels versus cleaner fuels, on the reported prevalence of asthma were estimated using multivariate logistic regression. Since the effects of cooking smoke are likely to be confounded with effects of tobacco smoking, age, and other such factors, the analysis was carried out after statistically controlling for such factors.
RESULTS：The results indicate that adult women living in households using biomass and solid fuels have a significantly higher risk of asthma than those living in households using cleaner fuels (OR: 1.26; 95%CI: 1.06-1.49; p = .010), even after controlling for the effects of a number of potentially confounding factors. Interestingly, this effect was not found among men (OR: 0.98; 95%CI: 0.77-1.24; p = .846). However, tobacco smoking was associated with higher asthma prevalence among both women (OR: 1.72; 95%CI: 1.34-2.21; p < .0001) and men (OR: 1.35; 95%CI: 1.49-2.25; p < .0001). Combined effects of biomass and solid fuel use and tobacco smoke on the risk of asthma were greater and more significant in women (OR: 2.16; 95%CI: 1.58-2.94; p < .0001) than they were in men (OR: 1.34; 95%CI: 1.04-1.72; p = .024).
CONCLUSIONS：The findings have important program and policy implications for countries such as India, where large proportions of the population still rely on polluting biomass fuels for cooking and heating. Decreasing household biomass and solid fuel use and increasing use of improved stove technology may decrease the health effects of indoor air pollution. More epidemiological research with better measures of smoke exposure and clinical measures of asthma is needed to validate the findings.
J Asthma. 2012 Mar 7. [Epub ahead of print]
方法：本研究入选的99574名女性和56742名男性（年龄为20～49岁）来自于2005～2006年印度第三次国家家庭健康调查。炊烟对报道的哮喘发病率的影响采用多变量logistic回归分析进行评价。炊烟通过使用的燃料（生物质和固体燃料及清洁燃料）类型进行确定。由于炊烟可能受到烟草烟雾、年龄和其他因素的影响，因此在对上述混杂因素控制后进行分析。
结果：结果显示，使用生物质和固体燃料烹调的家庭妇女，即使在对混杂因素进行控制后，哮喘发病风险显著高于采用清洁燃料的女性（OR: 1.26; 95%CI: 1.06-1.49; p=0.010）。有意思的是，该想象未见于男性（OR: 0.98; 95%CI: 0.77-1.24; p=0.846）。然而，烟草烟雾与男性（OR: 1.35; 95%CI: 1.49-2.25; p<0.0001）和女性（OR: 1.72; 95%CI: 1.34-2.21; p<0.0001）的哮喘发病率相关。生物质和固体燃料的使用和烟草烟雾对哮喘的合并影响，在女性中更明显（女性：OR: 2.16; 95%CI: 1.58-2.94; p<0.0001；男性：OR: 1.34; 95%CI: 1.04-1.72; p=0.024）
结论：我们结果对诸如印度这样的发展中国家制定相关政策具有借鉴作用，这些国家大部分人群仍然依赖于使用生物质燃料进行烹调和取暖。减少室内生物质和固体燃料的使用，改善炉灶的工艺，有可能降低室内空气污染对健康的影响。有必要进行更多的流行病学研究，采用更高级的手段检测烟雾暴露和临床哮喘，以验证本文的结论。
（陈欣 审校）
J Asthma. 2012 Mar 7. [Epub ahead of print]
Effect of Indoor Air Pollution from Biomass and Solid Fuel Combustion on Prevalence of Self-Reported Asthma among Adult Men and Women in India: Findings from a Nationwide Large-Scale Cross-Sectional Survey.
Agrawal S.
Source
South Asia Network for Chronic Disease, Public Health Foundation of India , New Delhi , India.
Abstract
OBJECTIVES：Increasing prevalence of asthma in developing countries has been a significant challenge for public health in recent decades. A number of studies have suggested that ambient air pollution can trigger asthma attacks. Biomass and solid fuels are a major source of indoor air pollution, but in developing countries the health effects of indoor air pollution are poorly understood. In this study we examined the effect of cooking smoke produced by biomass and solid fuel combustion on the reported prevalence of asthma among adult men and women in India.
METHODS：The analysis is based on 99,574 women and 56,742 men aged between 20 and 49 years included in India’s third National Family Health Survey conducted in 2005-2006. Effects of exposure to cooking smoke, determined by the type of fuel used for cooking such as biomass and solid fuels versus cleaner fuels, on the reported prevalence of asthma were estimated using multivariate logistic regression. Since the effects of cooking smoke are likely to be confounded with effects of tobacco smoking, age, and other such factors, the analysis was carried out after statistically controlling for such factors.
RESULTS：The results indicate that adult women living in households using biomass and solid fuels have a significantly higher risk of asthma than those living in households using cleaner fuels (OR: 1.26; 95%CI: 1.06-1.49; p = .010), even after controlling for the effects of a number of potentially confounding factors. Interestingly, this effect was not found among men (OR: 0.98; 95%CI: 0.77-1.24; p = .846). However, tobacco smoking was associated with higher asthma prevalence among both women (OR: 1.72; 95%CI: 1.34-2.21; p < .0001) and men (OR: 1.35; 95%CI: 1.49-2.25; p < .0001). Combined effects of biomass and solid fuel use and tobacco smoke on the risk of asthma were greater and more significant in women (OR: 2.16; 95%CI: 1.58-2.94; p < .0001) than they were in men (OR: 1.34; 95%CI: 1.04-1.72; p = .024).
CONCLUSIONS：The findings have important program and policy implications for countries such as India, where large proportions of the population still rely on polluting biomass fuels for cooking and heating. Decreasing household biomass and solid fuel use and increasing use of improved stove technology may decrease the health effects of indoor air pollution. More epidemiological research with better measures of smoke exposure and clinical measures of asthma is needed to validate the findings.
J Asthma. 2012 Mar 7. [Epub ahead of print]
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