BMJ  2005;331:1050 (5 November), doi:10.1136/bmj.38628.676088.55 (published 18 October 2005)

Paper

Improvement in household stoves and risk of chronic obstructive pulmonary disease in Xuanwei, China: retrospective cohort study

¹ College of Public Health, Chulalongkorn University, Institute Building 3, 10th Floor, Soi Chulalongkorn 62, Phyathai Road, Patumwan, Bangkok 10330, Thailand, ² Institute of Environmental Health and Engineering, Chinese Academy of Preventive Medicine, 29 Nan Wei Road, Beijing 100050, China, ³ Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, MSC 7240, 6120 Executive Blvd, EPS 8111, Bethesda, MD 20892, USA

Objective To test whether improvement in household coal stoves affected the incidence of chronic obstructive pulmonary disease (COPD) in Xuanwei County, China.

Design Retrospective cohort study (follow-up 1976-92) comparing incidence of COPD between groups with and without chimneys.

Participants 20 453 people born into homes with unvented coal stoves;16 606 (81.2%) subsequently changed to stoves with chimneys.

Intervention Installation of a chimney in households in which unvented stoves had been used previously.

Results Installation of a chimney was associated with distinct reduction in the incidence of COPD. Compared with people who did not have chimneys, the Cox-modelled risk ratio (relative risk) was 0.58 (95% confidence interval 0.49 to 0.70, P < 0.001) in men and 0.75 (0.62 to 0.92, P = 0.005) in women. Modelled risk ratios were robust to different Cox model specifications. Relative risks decreased with time since stove improvement. In both sexes, the reduction in risk became unequivocal about 10 years after stove improvement.

Conclusions In Xuanwei, incidence of COPD decreased markedly after household coal stoves were improved.

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