Ecotoxicology and Environmental Safety 230 (2022) 113104
Available online 23 December 2021
0147-6513/© 2021 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license
(http://creativecommons.org/licenses/by-nc-nd/4.0/).
Association of household solid fuel use and long-term exposure to PM
2.5
with arthritis in middle-aged and older population in China: A
cohort study
☆
Yu-Hong Liu
a
,
1
, Ya-Ke Lu
a
,
1
, Xiang-Tong Liu
a
,
b
, Yan-Ling Li
a
, Li-Kun Hu
a
, Hao-Yu Gao
a
,
Kun Yang
c
,
*
, Yu-Xiang Yan
a
,
b
,
**
a
Department of Epidemiology and Biostatistics, School of Public Health, Capital Medical University, Beijing 100069, China
b
Municipal Key Laboratory of Clinical Epidemiology, Beijing 100069, China
c
Department of Evidence-based Medicine, Xuanwu Hospital, Capital Medical University, Beijing 100069, China
ARTICLE INFO
Edited by Dr. Renjie Chen
Keywords:
PM
2.5
Solid fuel
Arthritis
Longitudinal study
Indoor air pollution
ABSTRACT
Air pollutants are common modiable risk factors for arthritis. To explore the longitudinal effects of air pollution
on arthritis based on a cohort study in middle-aged and elder people of China. Data was obtained from the China
Health and Retirement Longitudinal Study (CHARLS) from 2011 to 2018. A total of 7449 participants aged 45
years and older were involved in our study. The generalized linear mixed models were conducted to examine the
separate and joint effects of household air pollution and outdoor air pollution on arthritis, respectively. We found
a strong signicant association between air pollution and arthritis incidence. Individuals cooking primarily with
solid fuel were more likely in higher risk of arthritis compared with cleaner fuel (OR= 1.15; 95% CI: 1.08–1.23).
The group-based trajectory model identied four trajectory groups, compared with group “High-Decreasing
rapidly”, adjusted ORs of incident arthritis for group “Middle-Decreasing moderately”, “Low-Decreasing slowly”
and “Low-Stably” were 1.36 (95% CI, 1.03–1.79), 1.36 (95% CI, 1.01–1.83) and 1.81 (95% CI, 1.30–2.52),
respectively. These associations were generally higher in participants younger than 65 years. In addition, solid
fuel use and PM
2.5
exposure had additive and multiplicative effects on arthritis. The results suggested that solid
fuel use and long-term PM
2.5
exposure were associated with a higher incidence of arthritis. Therefore, it is
necessary to restrict solid fuel use to reduce household air pollution and make stronger environmental protection
policies to reduce PM
2.5
concentration.
1. Introduction
As a multifactorial and complex disease, arthritis is one of the leading
contributors to disability worldwide (Sari et al., 2020; Nalamachu
et al., 2021; Reina-Bueno et al., 2021). Over half of middle-aged and
elder adults suffer from arthritis, leading to chronic pain and poor
quality of life(Duncan et al., 2011; O’Donnell et al., 2015; Sun et al.,
2019). For the sake of the trend of gradual growth in aging populations
worldwide, the burden of arthritis for both individual and society is
expected to increase dramatically in the future. However, the patho-
genesis of arthritis remains unclear, as it may be triggered by various
factors, including environmental and genetic factors(McInnes and
Schett, 2011; Mathew and Ravindran, 2014; Karami et al., 2019).
Therefore, it is urgent to nd the modiable risk factors to reduce the
adverse impacts of arthritis.
Air pollutants are common modiable risk factors for arthritis(Gan
et al., 2013; Hart et al., 2013a, 2013b; Franchini and Mannucci, 2015).
The underlying biological mechanisms involved in the promotion of
arthritis development due to air pollution remain ill-dened, possibly
due to the augmentation of inammatory effects. As a chronic inam-
matory disease, the development of arthritis is associated with the
inltration of various inammatory cells and a crosstalk with cytokines
☆
This study was supported by the Program of Natural Science Fund of China (grant numbers 81573214, 82003559).
* Correspondence to: Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, China.
** Correspondence to: School of Public Health, Capital Medical University, No. 10 Xitoutiao, You’anmenWai, Fengtai District, Beijing 100069, China.
E-mail addresses: yangkun_1123@163.com (K. Yang), yanyxepi@ccmu.edu.cn (Y.-X. Yan).
1
These authors contributed equally to this work.
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Ecotoxicology and Environmental Safety
journal homepage: www.elsevier.com/locate/ecoenv
https://doi.org/10.1016/j.ecoenv.2021.113104
Received 7 October 2021; Received in revised form 2 December 2021; Accepted 15 December 2021