Key result
Housing disadvantages like coal heating are linked to ~71% higher heart disease risk.
Why the study?
Do housing disadvantages increase the risk of cardiovascular disease in middle-aged and older populations in China?
Cohort (n=9,843)
Yes
Do housing disadvantages increase the risk of cardiovascular disease in middle-aged and older populations in China?
Housing disadvantages, including the use of solid fuels for heating and unsafe sanitation, are significantly associated with an increased risk of incident heart disease and stroke in middle-aged and older Chinese adults.
BACKGROUND: Evidence for associations of housing disadvantages with cardiovascular disease (CVD) is scarce. This study aimed to assess the association of housing disadvantages with CVD among middle-aged and older populations in China. METHODS: We conducted analyses by data from China Health and Retirement Longitudinal Study, 2011-2018. CVD events were ascertained by self-reported data. A total of 9,843 individuals were included in stroke sub-cohort, and 8,752 individuals were included in heart disease sub-cohort. Cox regression was used to estimate hazard ratio (95% confidence interval (CI)) of housing disadvantages with CVD. Population attributable fractions were calculated through Levin's formula and Monte-Carlo simulation to estimate the CVD incidence associated with housing disadvantages in China. RESULTS: We found that using crops (HR = 1.35; 95% CI: 1.08-1.68) and coal fuel (HR: 1.71, 95%CI: 1.40-2.10) as heating energy sources were positively associated with heart disease risk compared to clean fuels. Unsafe sanitation was found to be associated with 43% (HR: 1.43, 95%CI: 1.23-1.66) higher heart disease risk and 30% (HR: 1.30, 95%CI: 1.06-1.60) higher stroke risk, and unsafe water source was positively associated with stroke risk (HR: 1.30, 95%CI: 1.08-1.56). Geographical disparities in CVD cases associated with housing disadvantages at a provincial level were found. Annually 1,380,000 cases (15.1%), 718,000 cases (7.9%), and 1,471,000 cases (16.1%) of heart diseases were associated with coal heating energy use, crop heating energy use, and unsafe sanitation, separately. 360,000 cases (12.1%) and 189,000 cases (6.4%) of strokes were associated with unsafe sanitation and unsafe water sources. Regions with lower socio-economic status had higher PAF. CONCLUSIONS: These findings suggested that housing disadvantages were associated with CVD risk in China and highlighted geographical inequality in cardiovascular diseases associated with housing disadvantages.
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Tao et al. (2025) conducted a cohort in Cardiovascular disease (n=9,843). Housing disadvantages (e.g., coal fuel heating, unsafe sanitation) vs. Clean fuels, safe sanitation, and safe water sources was evaluated on Heart disease (HR 1.71, 95% CI 1.40-2.10). Housing disadvantages, such as using coal fuel for heating, were associated with a higher risk of heart disease (HR 1.71; 95% CI 1.40-2.10) compared to clean fuels.
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