Household Stove Improvement and Risk of Lung Cancer in Xuanwei, China

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Abstract
Background: Lung cancer rates in rural Xuanwei County, Yunnan Province, are among the highest in China. Residents traditionally burned “smoky” coal in unvented indoor firepits that generated very high levels of air pollution. Since the 1970s, most residents have changed from firepits to stoves with chimneys. This study assessed whether lung cancer incidence decreased after this stove improvement. Methods: A cohort of 21 232 farmers, born from 1917 through 1951, was followed retrospectively from 1976 through 1992. All subjects were users of smoky coal who had been born into homes with unvented firepits. During their lifetime, 17 184 subjects (80.9%) changed permanently to stoves with chimneys. A hospital record search detected 1384 cases of lung cancer (6.5%) during follow-up. Associations of stove improvement with lung cancer incidence were analyzed with product-limit plots and multivariable Cox models. In 1995, indoor concentrations of airborne particles and benzo[a]pyrene were compared in Xuanwei homes during smoky coal burning in stoves with chimneys and in unvented stoves or firepits. Results: A long-term reduction in lung cancer incidence was noted after stove improvement. In Cox models, risk ratios (RRs) for lung cancer after stove improvement were 0.59 (95% confidence interval [CI] = 0.49 to 0.71) in men and 0.54 (95% CI = 0.44 to 0.65) in women (for both, P<.001). Incidence reduction became unequivocal about 10 years after stove improvement. Levels of indoor air pollution during burning with chimneys were less than 35% of levels during unvented burning. Conclusion: Changing from unvented to vented stoves appears to benefit the health of people in China and may do so in other developing countries as well.