Depression in the house: The effects of household air pollution from solid fuel use among the middle-aged and older population in China

https://doi.org/10.1016/j.scitotenv.2019.134706Get rights and content

Highlights

  • One of the first study to examine the association between HAP and depression.

  • A large nationally representative dataset was used.

  • We employed a matching strategy to remove selection bias in fuel choice.

  • Heterogeneous effects for vulnerable populations were estimated.

Abstract

Background

Although the adverse health effects of ambient air pollution are well documented, evidence on the depression effects of household air pollution (HAP) are scarce.

Objectives

We investigated the effects of HAP exposure from the use of solid fuel on depression using a nationally representative dataset of middle-aged and older population in China.

Methods

By employing the propensity score matching method, we first matched the type of household fuel based on background information, including demographic characteristics, lifestyles, health status, and household economic levels. Based on the matched data, we conducted OLS and logistic regressions with cluster standard error at community level to examine the effects of household solid fuel use on depression and adjusted for potential confounders. Heterogeneous effects for vulnerable population were also considered.

Results

We found a significantly higher Center for Epidemiologic Studies Depression Scale (CES-D) score and depression risk among current household solid fuel users. After matching and adjusting for potential confounders, current solid fuel users had a higher CES-D score of 0.59 (95% confidence interval [CI]: 0.31, 0.89) than clean fuel users. The OR of depression risk were 1.26 (95% CI: 1.14, 1.41). Solid fuel users had the highest CES-D scores (β = 0.99, 95% CI: 0.62, 1.36) and depression risk (OR = 1.49, 95% CI: 1.30, 1.73) for over five years. These associations were generally higher in females, participants aged 65 years and older, with a BMI ≥ 25, with low education, with low household economic levels, and those suffer from chronic diseases, including diabetes, chronic lung diseases, and cardiovascular diseases.

Conclusions

Exposure to HAP from solid fuel combustion was linked with strong depression outcomes. Findings suggested a need to strengthen public health efforts, such as controlling the social, health, and economic costs of depression by taking the physical environment, including HAP exposure, into account.

Section snippets

Background

Depression is one of the most common mental health problems nowadays. It results from a complex interaction of biological, physical, psychological, and social factors (Fuller-Thomson et al., 2016, Kessler and Bromet, 2013, Paykel, 2008). Depression has been experienced by a large number of elderly worldwide, which contributes to a high risk of disability, substantial expenditure on health services, decreased labor productivity, and thus, low quality of life which may even lead to suicide (Ekman

Data source

We obtained our data from the China Health and Retirement Longitudinal Study (CHARLS, website: http://charls.pku.edu.cn/zh-CN), a nationally representative longitudinal survey of more than 17,000 persons in China aged 45 years or older, covering 150 counties in 28 provinces. The study is biennially conducted by the National School of Development at Peking University. Ethical approval for the study was granted by the Ethical Review Committee of Peking University, and all participants provided

Summary of characteristics

A total of 9107 participants in wave 2015 were included in our study. Table 1 summarizes the characteristics of the study population across different fuel types. Over half (53.5%) were female with a mean age of 62.6 years old (SD: 9.33). The average CES-D score was 7.35 (SD: 6.06) and 9.07 (SD: 6.70) for current clean and solid fuel users, respectively. Compared with solid fuel users, participants who use clean fuel were more likely to suffer from a depression episode (28.4% and 39.4%). Two

Discussion

By using a matching method, household solid fuel use was found to have a significant effect on depression among the middle-aged and older population in China. This effect remained significant even after controlling for confounders like demographics, socioeconomic status, and health-related covariates. To our knowledge, this study is the first to employ a nationally representative data and matching technology to explore the relationship between HAP from solid fuel combustion and depression in

Conclusions

Depression is a common and costly mental disorder worldwide. Using matching data, we first provided evidence of significant associations between HAP from solid fuel use and depression among a representative sample of middle-aged and older population in China. Results show that long usage of solid fuel had major impacts on depression, considering the different groups classified by gender, age, BMI, and chronic disease presence. Women, individuals aged 65 years old and above, individuals

Declaration of Competing Interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Acknowledgements

Financial supports from National Natural Science Foundation of China (Grant Nos. 71572013, 71602009, 71872013, and 71432002), Beijing Municipal Social Science Foundation (Grant No: 18JDGLB040), Special Fund for Joint Development Program of Beijing Municipal Commission of Education, the James Tobin Research Fund at Yale Economics Department, Yale Macmillan Center faculty research award (2014-2016; 2017-2019), the U.S. PEPPER Center Scholar Award (P30AG021342), and two NIH/NIA grants (K01AG053408

References (60)

  • F.Z. Li et al.

    Ambient air pollution in china poses a multifaceted health threat to outdoor physical activity

    J. Epidemiol. Community Health

    (2015)
  • S.M.J. MohanKumar et al.

    Particulate matter, oxidative stress and neurotoxicity

    NeuroToxicology

    (2008)
  • M. Neupane et al.

    Sustained use of biogas fuel and blood pressure among women in rural Nepal

    Environ. Res.

    (2015)
  • V. Sass et al.

    The effects of air pollution on individual psychological distress

    Health Place

    (2017)
  • C. Vert et al.

    Effect of long-term exposure to air pollution on anxiety and depression in adults: a cross-sectional study

    Int. J. Hyg. Environ. Health

    (2017)
  • F. Wang et al.

    Ambient concentrations of particulate matter and hospitalization for depression in 26 Chinese cities: a case-crossover study

    Environ. Int.

    (2018)
  • Q. Wang et al.

    Does chronic disease influence susceptibility to the effects of air pollution on depressive symptoms in China?

    Int. J. Mental Health Syst.

    (2018)
  • X. Zhang et al.

    Happiness in the air: how does a dirty sky affect mental health and subjective well-being?

    J. Environ. Econ. Manage.

    (2017)
  • W.L. Zijlema et al.

    The association of air pollution and depressed mood in 70,928 individuals from four european cohorts

    Int. J. Hyg. Environ. Health

    (2016)
  • P.C. Austin

    The performance of different propensity score methods for estimating marginal hazard ratios

    Stat. Med.

    (2013)
  • N. Bates Michael et al.

    Acute lower respiratory infection in childhood and household fuel use in Bhaktapur, Nepal

    Environ. Health Perspect.

    (2013)
  • J. Baumgartner et al.

    Indoor air pollution and blood pressure in adult women living in rural China

    Environ. Health Perspect.

    (2011)
  • S. Bonjour et al.

    Solid fuel use for household cooking: country and regional estimates for 1980–2010

    Environ. Health Perspect.

    (2013)
  • B.W. Bresnahan et al.

    Averting behavior and urban air pollution

    Land Econ.

    (1997)
  • F.J. Charlson et al.

    The burden of mental, neurological, and substance use disorders in China and India: a systematic analysis of community representative epidemiological studies

    Lancet

    (2016)
  • S.T. Cheng et al.

    The center for epidemiologic studies depression scale in older Chinese: thresholds for long and short forms

    Int. J. Geriatric Psychiatry

    (2005)
  • L. Clark Maggie et al.

    Health and household air pollution from solid fuel use: the need for improved exposure assessment

    Environ. Health Perspect.

    (2013)
  • M.G. Cole et al.

    Risk factors for depression among elderly community subjects: a systematic review and meta-analysis

    Am. J. Psychiatry

    (2003)
  • M.M. Garrido et al.

    Methods for constructing and assessing propensity scores

    Health Serv. Res.

    (2014)
  • L.K. George et al.

    Social support and the outcome of major depression

    Br. J. Psychiatry

    (2018)
  • Cited by (0)

    View full text