Household Fuel Use and the Risk of Gastrointestinal Cancers: The Golestan Cohort Study.,Environmental Health Perspectives

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Household Fuel Use and the Risk of Gastrointestinal Cancers: The Golestan Cohort Study.
Environmental Health Perspectives ( IF 10.1 ) Pub Date : 2020-6-17 , DOI: 10.1289/ehp5907
Mahdi Sheikh _{1,

2} , Hossein Poustchi _{3,

4} , Akram Pourshams _{1,

4} , Masoud Khoshnia _{1,

5} , Abdolsamad Gharavi _{1,

5} , Mahdi Zahedi ₆ , Gholamreza Roshandel _{1,

5} , Sadaf G Sepanlou ₄ , Abdolreza Fazel ₇ , Maryam Hashemian _{1,

8} , Behrooz Abaei ₄ , Masoud Sotoudeh _{1,

3,

4} , Arash Nikmanesh _{1,

3,

4} , Shahin Merat _{3,

4} , Arash Etemadi _{1,

8} , Siavosh Nasseri Moghaddam _{1,

4} , Farhad Islami _{1,

9} , Farin Kamangar ₁₀ , Paul D Pharoah ₁₁ , Sanford M Dawsey ₈ , Christian C Abnet ₈ , Paolo Boffetta ₁₂ , Paul Brennan ₂ , Reza Malekzadeh _{1,

3,

4}

Affiliation

Digestive Oncology Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
Section of Genetics, International Agency for Research on Cancer, World Health Organization, Lyon, France.
Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
Digestive Disease Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran.
Ischemic Disorders Research Center, Golestan University of Medical Sciences, Gorgan, Iran.
Cancer Research Center, Golestan University of Medical Sciences, Gorgan, Iran.
Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA.
Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia, USA.
Department of Biology, School of Computer, Mathematical, and Natural Sciences, Morgan State University, Baltimore, Maryland, USA.
Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.

Abstract

Background:

Three billion people burn nonclean fuels for household purposes. Limited evidence suggests a link between household fuel use and gastrointestinal (GI) cancers.

Objectives:

We investigated the relationship between indoor burning of biomass, kerosene, and natural gas with the subsequent risk of GI cancers.

Methods:

During the period 2004–2008, a total of 50,045 Iranian individuals 40–75 years of age were recruited to this prospective population-based cohort. Upon enrollment, validated data were collected on demographics, lifestyle, and exposures, including detailed data on lifetime household use of different fuels and stoves. The participants were followed through August 2018 with $less than 1 percent$ loss.

Results:

During the follow-up, 962 participants developed GI cancers. In comparison with using predominantly gas in the recent 20-y period, using predominantly biomass was associated with higher risks of esophageal [hazard ratio (HR): 1.89; 95% confidence interval (CI): 1.02, 3.50], and gastric HR: 1.83; 95% CI: 1.01, 3.31) cancers, whereas using predominantly kerosene was associated with higher risk of esophageal cancer (HR: 1.84; 95% CI: 1.10, 3.10). Lifetime duration of biomass burning for both cooking and house heating (exclusive biomass usage) using heating-stoves without chimney was associated with higher risk of GI cancers combined (10-y HR: 1.14; 95% CI: 1.07, 1.21), esophageal (10-y HR: 1.19; 95% CI: 1.08, 1.30), gastric (10-y HR: 1.11; 95% CI: 1.00, 1.23), and colon (10-y HR: 1.26; 95% CI: 1.03, 1.54) cancers. The risks of GI cancers combined, esophageal cancer, and gastric cancer were lower when biomass was burned using chimney-equipped heating-stoves (strata difference $p-values equals 0.001$ , 0.003, and 0.094, respectively). Duration of exclusive kerosene burning using heating-stoves without chimney was associated with higher risk of GI cancers combined (10-y HR: 1.05; 95% CI: 1.00, 1.11), and esophageal cancer (10-y HR: 1.14; 95% CI: 1.04, 1.26).

Discussion:

Household burning of biomass or kerosene, especially without a chimney, was associated with higher risk of some digestive cancers. Using chimney-equipped stoves and replacing these fuels with natural gas may be useful interventions to reduce the burden of GI cancers worldwide. https://doi.org/10.1289/EHP5907

中文翻译：

家庭燃料使用和胃肠道癌症的风险：Golestan 队列研究。

抽象的

背景：

三十亿人燃烧非清洁燃料用于家庭用途。有限的证据表明家庭燃料使用与胃肠道 (GI) 癌症之间存在联系。

目标：

我们研究了室内燃烧生物质、煤油和天然气与随后患胃肠道癌症的风险之间的关系。

方法：

2004 年至 2008 年期间，共有 50,045 名 40 至 75 岁的伊朗人被招募到这个基于人群的前瞻性队列中。登记后，收集了有关人口统计、生活方式和暴露的经过验证的数据，包括家庭终生使用不同燃料和炉灶的详细数据。 2018 年 8 月对参与者进行了跟踪调查 $less than 1 percent$ 损失。

结果：

在随访期间，962 名参与者患上了胃肠道癌症。与近 20 年来主要使用天然气相比，主要使用生物质与较高的食管风险相关[风险比 (HR)：1.89； 95% 置信区间 (CI)：1.02, 3.50]，胃 HR：1.83； 95% CI: 1.01, 3.31) 癌症，而主要使用煤油则与较高的食管癌风险相关 (HR: 1.84; 95% CI: 1.10, 3.10)。使用无烟囱的加热炉烹饪和房屋取暖（仅使用生物质）燃烧生物质的生命周期与胃肠道癌症的综合风险较高相关（10年HR：1.14；95％CI：1.07，1.21），食管癌（ 10 年 HR：1.19；95% CI：1.08，1.30），胃（10 年 HR：1.11；95% CI：1.00，1.23）和结肠（10 年 HR：1.26；95% CI：1.03） 1.54）癌症。当使用配备烟囱的加热炉燃烧生物质时，胃肠道癌、食道癌和胃癌的风险较低（分层差异 $p-values equals 0.001$ 、 0.003 和 0.094 ，分别）。使用无烟囱的加热炉单独燃烧煤油的持续时间与胃肠道癌（10 年 HR：1.05；95% CI：1.00，1.11）和食道癌（10 年 HR：1.14；95%）的综合风险较高相关。置信区间：1.04、1.26）。