Solid fuel use, socioeconomic indicators and risk of cardiovascular diseases and all-cause mortality: a prospective cohort study in a rural area of Sichuan, China.

BACKGROUND: Estimates indicate that household air pollution caused by solid fuel burning accounted for about 1.03 million premature mortalities in China in 2016. In the country's rural areas, more than half the population still relies on biomass fuels and coals for cooking and heating. Understanding the health impact of indoor air pollution and socioeconomic indicators is essential for the country to improve its developmental targets. We aimed to describe demographic and socioeconomic characteristics associated with solid fuel users in a rural area in China. We also estimated the risk of cardiovascular disease and all-cause mortality in association with solid fuel use and described the relationship between solid fuel use, socioeconomic status and mortality. We also measured the risk of long-term use, and the effect of ameliorative action, on mortality caused by cardiovascular disease and other causes. METHODS: We used the China Kadoorie Biobank (CKB) site in Pengzhou, Sichuan, China. We followed a cohort of 55 687 people over 2004-13. We calculated the mean and standard deviation among subgroups classified by fuel use types: gas, coal, wood and electricity (central heating additionally for heating). We tested the mediation effect using the stepwise method and Sobel test. We used Cox proportional models to estimate the risk of incidences of cardiovascular disease and mortality with survival days as the time scale, adjusted for age, gender, socioeconomic status, physical measurements, lifestyle, stove ventilation and fuel type used for other purposes. The survival days were defined as the follow-up days from the baseline survey till the date of death or 31 December 2013 if right-censored. We also calculated the absolute mortality rate difference (ARD) between the exposure group and the reference group. RESULTS: The study population had an average age of 51.0, and 61.9% of the individuals were female; 64.8% participants (n = 35 543) cooked regularly and 25.4% participants (n = 13 921) needed winter heating. With clean fuel users as the reference group, participant households that used solid fuel for cooking or heating both had a higher risk of all-cause mortality: hazard ratio (HR) for: cooking, 1.11 [95% confidence interval (CI) 1.02, 1.26]; heating, 1.34 (95% CI 1.16, 1.54). Solid fuel used for winter heating was associated with a higher risk of mortality caused by cerebrovascular disease: HR 1.64 (95% CI 1.12, 2.40); stroke: HR 1.70 (95% CI 1.13, 2.56); and cardiovascular disease: HR 1.49 (95% CI 1.10, 2.02). Low income and poor education level had a significant correlation with solid fuel used for cooking: odds ratio (OR) for income: 2.27 (95% CI 2.14, 2.41); education: 2.34 (95% CI 2.18, 2.53); and for heating: income: 2.69 (95% CI 2.46, 2.97); education: 2.05 (95% CI 1.88, 2.26), which may be potential mediators bridging the effects of socioeconomic status factors on cardiovascular disease and all-cause mortality. Solid fuel used for cooking and heating accounted for 42.4% and 81.1% of the effect of poor education and 55.2% and 76.0% of the effect of low income on all-cause mortality, respectively. The risk of all-cause mortality could be ameliorated by stopping regularly cooking and heating using solid fuel or switching from solid fuel to clean fuels: HR for cooking: 0.90 (95% CI 0.84, 0.96); heating: 0.76 (95% CI 0.64, 0.92). CONCLUSIONS: Our study reinforces the evidence of an association between solid fuel use and risk of cardiovascular disease and all-cause mortality. We also assessed the effect of socioeconomic status as the potential mediator on mortality. As solid fuel use was a major contributor in the effect of socioeconomic status on cardiovascular disease and all-cause mortality, policies to improve access to clean fuels could reduce morbidity and mortality related to poor education and low income.

Dynamic evolution analysis of the factors driving the growth of energy-related CO2 emissions in China: An input-output analysis.

In recent years, the global greenhouse effect caused by excessive energy-related carbon emissions has attracted more and more attention. In this paper, we studied the dynamic evolution of factors driving China's energy-related CO2 emissions growth from 2007 to 2015 by using energy consumption method and input-output analysis and used the IO-SDA model to decompose the energy carbon emissions. Within the research interval, the results showed that (1) on the energy supply-side, the high carbon energy represented by raw coal was still the main factor to promote the growth of energy-related CO2 emissions. However, the optimization of energy consumption structure is conducive to reducing emissions. Specifically, the high carbon energy represented by raw coal exhibited a downward trend in promoting the increment of energy-related CO2 emissions, while the clean energy represented by natural gas showed an upward trend in promoting the increment of CO2 emissions. It is worth noting that there is still a lot of room for optimization of China's energy consumption structure to reduce emissions. (2) On the energy demand-side, the final demand effect is the main driving force of the growth of carbon emissions from fossil energy. Among them, the secondary industry plays a major role in the final demand effect. The "high carbonization" of the final product reflects the characteristics of China's high energy input in the process of industrialization. At the same time, since the carbon emission efficiency of the tertiary industry and the primary industry is better than that of the secondary industry, actively optimizing the industrial structure is conducive to slowing down the growth of carbon emission brought by the demand effect. (3) The input structure effect is the main restraining factor for the growth of energy carbon emissions, while the energy intensity effect has a slight driving effect on the growth of energy carbon emissions. The results show that China's "extensive" economic growth model has been effectively reversed, but the optimization of fossil energy utilization efficiency is still not obvious, and there is still a large space to curb carbon emissions by improving fossil energy utilization efficiency in the future.

Contamination identification, source apportionment and health risk assessment of trace elements at different fractions of atmospheric particles at iron and steelmaking areas in China.

China has the largest share of global iron and steel production, which is considered to play a significant contribution to air pollution. This study aims to investigate trace element contamination at different fractions of particulate matter (PM) at industrial areas in China. Three PM fractions, PM2.1-9.0, PM1.1-2.1 and PM1.1, were collected from areas surrounding iron and steelmaking plants at Kunming, Wuhan, Nanjing and Ningbo in China. Multiple trace elements and their bioavailability, as well as Pb isotopic compositions, were analysed for identification of contaminants, health risk assessment and source apportionment. Results showed that PM particles in the sites near industrial areas were associated with a range of toxic trace elements, specifically As, Cr(VI), Cd and Mn, and posed significant health risks to humans. The isotopic Pb compositions identified that coal and high temperature metallurgical processes in the steelmaking process were the dominant contributors to local air pollution in these sites. In addition to iron and steelmaking activities, traffic emissions and remote pollution also played a contributing role in PM contamination, confirmed by the differences of Pb isotopic compositions at each PM fraction and statistical results from Preference Ranking Organization Method for Enrichment Evaluations (PROMETHEE) and Geometrical Analysis for Interactive Aid (GAIA). The results presented in this study provide a comprehensive understanding of PM emissions at iron and steelmaking areas, which helps to guide subsequent updates of air pollution control guidelines to efficiently minimise environmental footprint and ensure long term sustainability of the industries.

Impacts of Coal Use on Health.

This article reviews evidence for the public health impacts of coal across the extraction, processing, use, and waste disposal continuum. Surface coal mining and processing impose public health risks on residential communities through air and water pollution. Burning coal in power plants emits more nitrogen oxides, sulfur dioxide, particulate matter, and heavy metals per unit of energy than any other fuel source and impairs global public health. Coal ash disposal exposes communities to heavy metals and particulate matter waste. Use of coal in domestic households causes public health harm concentrated in developing nations. Across the coal continuum, adverse impacts are disproportionately felt by persons of poor socioeconomic status, contributing to health inequities. Despite efforts to develop renewable energy sources, coal use has not declined on a global scale. Concentrated efforts to eliminate coal as an energy source are imperative to improve public health and avert serious climate change consequences.

DNA damage assessment with buccal micronucleus cytome assay in Turkish coal miners.

The aim of this study was to assess DNA damage in Turkish coal miners with the buccal micronucleus cytome (BMCyt assay as the least invasive and therefore most practical method that may find wider application in coal miner biomonitoring. Buccal epithelial cell samples were taken from 54 coal miners and 42 controls from Zonguldak, Turkey to establish their micronucleus (MN), binucleus (BN), condensed chromatin (CC), karyorrhectic (KHC), karyolytic (KYL), nuclear bud (NBUD), and pyknotic (PYC) frequencies. We also analysed the effects of confounding factors such as age, years of work at the mine, smoking, alcohol drinking, and use of protective equipment on differences in MN frequencies. Two miners had confirmed and three suspect pneumoconiosis, whereas 49 displayed normal chest radiographs. MN, BN, KHC, and NBUD frequencies were significantly higher in coal miners than controls. Years of work at the mine also showed a significant effect on buccal MN frequencies in coal miners, but we found no correlation between MN frequencies and age, smoking, and alcohol consumption. In conclusion, BMCyt assay proved itself an accurate and practical screening method, as it can detect DNA damage much earlier than pneumoconiosis develops.

[Occupational health risk assessment of coal dust in coal industry chain].

Objective: To grasp the present situation of occupational hazards of coal dust in our country, understand our country coal dust workers' occupational health risks, provide information based on evidence and analysis for the government and organize to effectively deal with the current status of high coal workers pneumoconiosis incidence in China, and protect coal dust workers' occupational health. Methods: The research object is the " mining-transportation-use" of coal industrial chain, referring to 33 units. Use field investigation to obtain the coal dust exposure, dust prevention measures and the occupational health data of study object. Use quantitative evaluation method of International council on mining and metals occupational health risk assessment model (ICMM method) and occupational hazard risk index method (index method) , with coal workers pneumoconiosis as health outcomes, to evaluate the coal dust occupational health risks of coal industrial chain. Results: The free silica content of partial coal dust in China is more than 10%, and even to 19.5%. coal dust concentration in workplaces, such as excavating system of dust coal mining (total dust: 22.1~46.5 mg/m(3), respiratory dust: 8.4~17.7 mg/m(3)) , dumper (total dust: 25.2 mg/m(3), respiratory dust: 6.9 mg/m(3)) , transfer tower (total dust: 35.4 mg/m(3)) of coal transportation and belt coal plough device of coal use (total dust: 36.3 mg/m(3), respiratory dust: 14.0 mg/m(3)) , are much higher than those in other workplaces, and coal dust concentration of workers in these places (2.6~9.3 mg/m(3)) are much higher than those in other places, which are statistically significant. ICMM method evaluation results show that the risk value of excavating system is between 504~1 089, and the risk value of comprehensive mining system is between 347~2 040, which are far statistically significant higher than that of other systems. Index method evaluation results (excavating system risk value between 3.1~9.7, fully mechanized system risk value between 3.7~9.3) , are basically identical with ICMM method (correlation coefficient r=0.857, P<0.01) . The new cases of coal worker pneumoconiosis are distributed in three post of coal mining, excavating and coal mine mixing. Conclusion: Coal-dust hazards are widely distributed in the coal "mining, transportation, and use" industrial chain, which of the underground coal mine is as serious as intolerable, meanwhile the risk of other industrial chain is basically can tolerable. The high coal dust concentration and the high risk of coal dust occupational hazard are concentrated in the excavating system and the comprehensive mining system. It is recommended to start the study on risk assessment and risk response of coal dust health hazard at the national level, and the occupational exposure limit of coal dust should be established according to the content of free silica.

Exploring the determinants of health and wellbeing in communities living in proximity to coal seam gas developments in regional Queensland.

BACKGROUND: There is some concern that coal seam gas mining may affect health and wellbeing through changes in social determinants such as living and working conditions, local economy and the environment. The onward impact of these conditions on health and wellbeing is often not monitored to the same degree as direct environmental health impacts in the mining context, but merits attention. This study reports on the findings from a recurrent theme that emerged from analysis of the qualitative component of a comprehensive Health Needs Assessment (HNA) conducted in regional Queensland: that health and wellbeing of communities was reportedly affected by nearby coal seam gas (CSG) development beyond direct environmental impacts. METHODS: Qualitative analysis was initially completed using the Framework Method to explore key themes from 11 focus group discussions, 19 in-depth interviews, and 45 key informant interviews with health and wellbeing service providers and community members. A key theme emerged from the analysis that forms the basis of this paper. This study is part of a larger comprehensive HNA involving qualitative and quantitative data collection to explore the health and wellbeing needs of three communities living in proximity to CSG development in regional Queensland, Australia. RESULTS: Communities faced social, economic and environmental impacts from the rapid growth of CSG development, which were perceived to have direct and indirect effects on individual lifestyle factors such as alcohol and drug abuse, family relationships, social capital and mental health; and community-level factors including social connectedness, civic engagement and trust. CONCLUSIONS: Outer regional communities discussed the effects of mining activity on the fabric of their town and community, whereas the inner regional community that had a longer history of industrial activity discussed the impacts on families and individual health and wellbeing. The findings from this study may inform future health service planning in regions affected by CSG in the development /construction phase and provide the mining sector in regional areas with evidence from which to develop social responsibility programs that encompass health, social, economic and environmental assessments that more accurately reflect the needs of the affected communities.

[Study on application of two risk assessment methods in coal dust occupational health risk assessment].

Objective: To evaluate the applicability of quantitative grading method (GBZ/T 229.1-2010) and occupational hazard risk index method in coal dust occupational health risk assessment. Methods: Taking 4 coal mines as the research object of risk assessment and making occupational health field testing and investigation. Based on two risk assessment methods, we analysed the health risk levels of 20 occupations which were exposed to coal dust in workplaces. Results: Coal dust working post had different risk levels in 4 coal mines, the post of higher risk level were mainly concentrated in the underground workplace of coal mine, especially the post of coal mining and tunneling system. The two risk assessment results showed that the risk levels of coal-mining machine drivers and tunneling machine drivers were the highest. The risk levels of coal dust working post used by two risk assessment methods had no significant difference (P>0.05) and were highly correlated (r=0.821, P<0.001) . Evaluation results of two risk assessment methods were supported by the field investigation and literatures. Conclusion: The two risk assessment methods can be used in coal dust occupational health risk assessment.

[Risk assessment of occupational health effect of coal dust in coal wharf].

OBJECTIVE: To assess the occupational health risk of coal dust in coal wharf, identify the high risk post. METHODS: The research took workers who were exposed to coal dust in two 50- 150 thousands tons coal wharfs around bohai as subjects. The field investigation to get the infoamtion of production technology, distribution of coal dust, free silica content of coal dust, dust prevention measures and facilities, personal protection equipment, occupational health management, etc were used. The coal dust concentration of workplaces and the main positions were detected by filter membrane weighing method. The health risk of the coal dust to the main posts were assessed with the InternationalCouncil on Mining and Metals risk assessment method and occupational hazard risk index method. RESULTS: In the coal wharf, the concentration of coal dust at transferring tower, car dumper, ship loader, and coal storage yard were higher than other workplace, range of concentration: total dust 8. 8-85. 1 mg/m~3, respirable dust 2. 3- 32. 3 mg/m~3。The assessing result of ICMM method was that, 78. 6% of the posts were at "intolerable"level of occupational risk. The risk values of the driver of car dumper( 1500, 5000), the hatch commander( 1500), and the cleaners of coal storage yard( 900) were higher than transfer tower patrol workers( 600), drivers of material piling and taking machine( 450). The assessing result of occupational hazard risk index method was that, the risk degree of total dustand respirable dusttothe driver of car dumper was "severe"and "moderate"( the risk index was 40. 03 and 16. 95, respectively), and the risk degree of the total dust to the cleaners of coal unloading department and coal storage yard were "light"( the risk index was 6. 02 and 8. 70, respectively), with other posts' "no harm ". CONCLUSION: The occupational hazard of coal wharf is focused on the processes of loading and unloading( "severe"and"moderate"), transferring( "light") and reentrainment( "light").

Underground Coal Mining: Relationship between Coal Dust Levels and Pneumoconiosis, in Two Regions of Colombia, 2014.

In Colombia, coal miner pneumoconiosis is considered a public health problem due to its irreversibility, high cost on diagnosis, and lack of data related to its prevalence in the country. Therefore, a cross-sectional study was carried out in order to determine the prevalence of pneumoconiosis in underground coal mining workers in two regions of Colombia. The results showed a 35.9% prevalence of pneumoconiosis in the study group (42.3% in region 1 and 29.9% in region 2). An association was found between a radiologic diagnosis of pneumoconiosis and a medium risk level of exposure to carbon dust (OR: 2.901, 95% CI: 0.937, 8.982), medium size companies (OR: 2.301, 95% CI: 1.260-4.201), length of mining work greater than 25 years (OR: 3.222, 95% CI: 1.806-5.748), and a history of smoking for more than one year (OR: 1.479, 95% CI: 0.938-2.334). These results establish the need to generate an intervention strategy aimed at preventing the identified factors, as well as a timely identification and effective treatment of pneumoconiosis in coal miners, in which the commitment of the General Health and Social Security System and the workers compensation system is ensured.

Cost-Effectiveness of Coal Workers' Pneumoconiosis Prevention Based on Its Predicted Incidence within the Datong Coal Mine Group in China.

We aimed to estimate the economic losses currently caused by coal workers' pneumoconiosis (CWP) and, on the basis of these measurements, confirm the economic benefit of preventive measures. Our cohort study included 1,847 patients with CWP and 43,742 coal workers without CWP who were registered in the employment records of the Datong Coal Mine Group. We calculated the cumulative incidence rate of pneumoconiosis using the life-table method. We used the dose-response relationship between cumulative incidence density and cumulative dust exposure to predict the future trend in the incidence of CWP. We calculate the economic loss caused by CWP and economic effectiveness of CWP prevention by a step-wise model. The cumulative incidence rates of CWP in the tunneling, mining, combining, and helping cohorts were 58.7%, 28.1%, 21.7%, and 4.0%, respectively. The cumulative incidence rates increased gradually with increasing cumulative dust exposure (CDE). We predicted 4,300 new CWP cases, assuming the dust concentrations remained at the levels of 2011. If advanced dustproof equipment was adopted, 537 fewer people would be diagnosed with CWP. In all, losses of 1.207 billion Renminbi (RMB, official currency of China) would be prevented and 4,698.8 healthy life years would be gained. Investments in advanced dustproof equipment would be total 843 million RMB, according to our study; the ratio of investment to restored economic losses was 1:1.43. Controlling workplace dust concentrations is critical to reduce the onset of pneumoconiosis and to achieve economic benefits.

Childhood illness in households using biomass fuels in India: secondary data analysis of nationally representative national family health surveys.

BACKGROUND: Half of the world's population uses solid fuels for energy and cooking, resulting in 1.5 million deaths annually, approximately one-third of which occur in India. Most deaths are linked to childhood pneumonia or acute lower respiratory tract infection (ALRI), conditions that are difficult to diagnose. The overall effect of biomass combustion on childhood illness is unclear. OBJECTIVES: To evaluate whether type of household fuel is associated with symptoms of ALRI (cough and difficulty breathing), diarrhea or fever in children aged 0-36 months. METHODS: We analyzed nationally representative samples of households with children aged 0-36 months from three national family health surveys conducted between 1992 and 2006 in India. Households were categorized as using low (liquid petroleum gas/electricity), medium (coal/kerosene) or high polluting fuel (predominantly wood/agricultural waste). Odds ratios adjusted for confounders for exposure to high and medium polluting fuel were compared with low polluting fuel (LPF). RESULTS: Use of high polluting fuel (HPF) in India changed minimally (82 to 78 %), although LPF use increased from 8% to 18%. HPF was consistently associated with ALRI [adjusted odds ratio (95% confidence interval) 1.48 (1.08-2.03) in 1992-3; 1.54 (1.33-1.77) in 1998-9; and 1.53 (1.21-1.93) in 2005-6). Fever was associated with HPF in the first two surveys but not in the third survey. Diarrhea was not consistently associated with HPF. CONCLUSIONS: There is an urgent need to increase the use of LPF or equivalent clean household fuel to reduce the burden of childhood illness associated with IAP in India.

The mining and burning of coal: effects on health and the environment.

Australia's coal conundrum is that all political parties say they are concerned about climate change while sanctioning an unprecedented expansion of coalmining and coal seam gas extraction in Australia. Australia's coal contributes to climate change and its global health impacts. Each phase of coal's lifecycle (mining, disposal of contaminated water and tailings, transportation, washing, combustion, and disposing of postcombustion wastes) produces pollutants that affect human health. Communities in which coalmining or burning occurs have been shown to suffer significant health impacts. The health and climate costs of coal are unseen, and when costs to health systems are included, coal is an expensive fuel.

The fox guarding the chicken coop: monitoring exposure to respirable coal mine dust, 1969-2000.

Following passage of the Coal Mine Health and Safety Act of 1969, underground coal mine operators were required to take air samples in order to monitor compliance with the exposure limit for respirable dust, a task essential for the prevention of pneumoconiosis among coal workers. Miners objected, claiming that having the mine operators perform this task was like "having the fox guard the chicken coop." This article is a historical narrative of mining industry corruption and of efforts to reform the program of monitoring exposure to coal mine dust. Several important themes common to the practice of occupational health are illustrated; most prominently, that employers should not be expected to regulate themselves.

Regulations implementing the Federal Coal Mine Health and Safety Act of 1969, as amended. Employment Standards Administration, Labor. Final rule.

On January 22, 1997, the Department issued a proposed rule to amend the regulations implementing the Black Lung Benefits Act. 62 FR 3338-3435 (Jan. 22, 1997). When the comment period closed on August 21, 1997, the Department had received written submissions from almost 200 interested persons, including coal miners, coal mine operators, insurers, physicians, and attorneys. The Department also held hearings in Charleston, West Virginia, and Washington, D.C. at which over 50 people testified. The Department carefully reviewed the testimony and the comments and, on October 8, 1999, issued a second notice of proposed rulemaking. 64 FR 54966-55072 (Oct. 8, 1999). In its second notice, the Department proposed changing several of the most important provisions in its initial proposal. The Department also explained its decision not to alter the original proposal with respect to other key regulations based on the comments received to date. Finally, the Department prepared an initial regulatory flexibility analysis. In order to ensure that small businesses that could be affected by the Department's proposal received appropriate notice of the Department's proposed changes, the Department mailed a copy of the second notice of proposed rulemaking to all coal mine operators contained in the databases maintained by the Mine Safety and Health Administration. The Department initially allowed interested parties until December 7, 1999 to file comments to its second proposal, but extended that period until January 6, 2000. The Department received 37 written submissions before the close of the comment period, from groups representing both coal miners and coal mine operators. The Department also received comments from individual miners, various coal mining and insurance companies, as well as from claims processing organizations, attorneys, and various professional organizations. The Department has carefully reviewed all of the comments, and is issuing its final rule. The rule contains a final regulatory flexibility analysis as required by the Regulatory Flexibility Act.