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    Don't cook or heat with coal and firewood; switch to electricity or gas

    • High value
    • Evidence A
    • Buys life
    • Costs a lot
    • Takes minutes
    • No willpower

    In plain words

    People who cook with coal or firewood have about a 10% higher chance of dying over the same period; those who heat with coal or firewood are about 14% higher. People who have switched to electricity or gas have a 13%โ€“33% lower chance of dying than people still burning coal or firewood.

    Cost

    A rural household has to change its stove, and with fuel costs that is a few hundred to over 1000 CNY a year. You change once and it's done, with no ongoing time. Most city dwellers already use electricity or gas.

    What you get

    A Chinese chronic disease follow-up study (observational, not assigning groups) of 271,000 (27.1ไธ‡) adults without cardiovascular disease. People who cooked with solid fuels such as coal and firewood had about 11% higher risk of death than people who used electricity or gas (HR 1.11). People who heated with solid fuels were about 14% higher (HR 1.14). People who had switched from solid to clean fuels, compared with those still burning, were about 13% lower for cooking (HR 0.87). For heating it was about 33% lower (HR 0.67). Outdoor PM2.5 is a separate account. Pooling 104 follow-up studies, each 10 ยตg/mยณ higher in long-term exposure raised the risk of death from natural causes by about 8% (RR 1.08). Natural causes means deaths from disease rather than accidents.

    Notes

    These studies only followed people. Households that switched fuel are often also better off, so the โ€œrisk drops to 0.67 timesโ€ number is mixed with the effect of household wealth. As for outdoor PM2.5, there is little an individual can do beyond moving, wearing a mask or using an air purifier. There are no studies of air purifiers with mortality as the outcome, so this section gives no figure.

    Evidence grade
    A : Specific numbers from meta-analyses, large cohorts or randomized trials; for law and policy, the statute or official text.
    Sources
    1. Yu K et al. (2018). Association of Solid Fuel Use With Risk of Cardiovascular and All-Cause Mortality in Rural China. JAMA. https://doi.org/10.1001/jama.2018.2151
    2. Chen J, Hoek G (2020). Long-term exposure to PM and all-cause and cause-specific mortality: A systematic review and meta-analysis. Environment International. https://doi.org/10.1016/j.envint.2020.105974

    Mentioned in

    Translated from the Chinese original. Original book, section 2, tip 29. This section is about health and medicines. It is general information, not a substitute for a doctorโ€™s diagnosis or prescription. Content may be out of date and rules differ by place. When you actually deal with an agency, a doctor or a court, follow what local officials, doctors and lawyers tell you. Disclaimer