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Adverse health effects associated with household air pollution: a systematic review, meta-analysis, and burden estimation study

Lee, Kuan Ken, Bing, Rong, Kiang, Joanne, Bashir, Sophia, Spath, Nicholas, Stelzle, Dominic, Mortimer, Kevin ORCID:, Bularga, Anda, Doudesis, Dimitrios, Joshi, Shruti S, Strachan, Fiona, Bonjour, Sophie, Adair-Rohani, Heather, Attia, Engi F, Chung, Michael H, Miller, Mark R, Newby, NewbyDavid E, Mills, Nicholas L, McAllister, David A and Shah, Anoop SV (2020) 'Adverse health effects associated with household air pollution: a systematic review, meta-analysis, and burden estimation study'. Lancet Global Health, Vol 8, Issue 11, E1427-E1434.

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Background: Three billion people worldwide rely on polluting fuels and technologies for domestic cooking and heating. We estimate the global, regional and national health burden associated with exposure to household air pollution.

Methods: Four databases were systematically searched for studies evaluating the risk of adverse cardiorespiratory, paediatric and maternal outcomes from household air pollution exposure and a random-effects model was used to calculate disease-specific risk meta-estimates. Household air pollution exposure was defined as use of polluting fuels (coal, wood, charcoal, agricultural wastes, animal dung or kerosene) for household cooking or heating. Temporal trends in mortality and burden associated with household air pollution were estimated from 2000 to 2017 using exposure prevalence data from 183 of 193 United Nations member states.

Findings: Four hundred and seventy six studies (n=15·5 million participants) from 123 nations (80% [99/123] classified as low- and middle-income) met the inclusion criteria. Using a counterfactual of no exposure, household air pollution was positively associated with chronic obstructive pulmonary disease, acute respiratory infection, ischaemic heart disease and cerebrovascular disease, and under-five, respiratory and cardiovascular mortality. Household air pollution was associated with 1·8 million deaths (95%CI 1·1-2·7) and 60·9 million disability-adjusted life years (95%CI 34·6-93·3) in 2017 with the burden overwhelmingly experienced in low- and middle-income nations compared to high-income nations (60·8 million [95%CI 34·6-92·9] versus 0·09 million [95%CI 0·01-0·40], respectively). From 2000, household air pollution associated mortality and burden has reduced by 36% (95%CI 29%-43%) and 30% (95%CI 25%-36%) respectively, with the greatest reductions observed in higher income nations.

Interpretation: The burden of cardiorespiratory, paediatric and maternal diseases associated with household air pollution has declined worldwide but remains high in the world’s poorest regions. Urgent integrated health and energy strategies are needed to reduce the adverse health impact of household air pollution, especially in low- and middle-income nations.

Item Type: Article
Subjects: WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries
WA Public Health > Air pollution > WA 750 Air sanitation and hygiene
WA Public Health > Air pollution > WA 754 Pollution and pollutants (incl. tobacco pollution; passive smoking)
WA Public Health > Housing. Buildings. Public Facilities > WA 795 Housing
Faculty: Department: Clinical Sciences & International Health > Clinical Sciences Department
Digital Object Identifer (DOI):
Depositing User: Julie Franco
Date Deposited: 16 Oct 2020 13:08
Last Modified: 16 Oct 2020 13:08


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