Effects of long-term household air pollution exposure from solid fuel use on depression: Evidence from national longitudinal surveys from 2011 to 2018

Evidence of the effects of long-term household air pollution (HAP) on human mental health is limited. This study aimed to explore the longitudinal relationship between long-term household air pollution exposure from solid fuel use and depression based on nationally representative follow-up dataset. A total of 7005 middle- and old-age adults from the latest four waves (2011, 2013, 2015, and 2018) of China Health and Retirement Longitudinal Study (CHARLS) were involved. The Center for Epidemiologic Studies Depression scale (CES-D 10) was used to measure depressive symptoms and individuals who got more than 12 points were considered to have depression symptoms. We conducted Cox proportional hazards regression models to examine the association between household air pollution and depression in overall population, and subgroup stratified by socio-demographic factors, lifestyle behaviors, chronic diseases, and residential environments. We found long-term household air pollution exposure from solid fuel use was significantly associated with higher depression risk among Chinese older adults (HR 1.27, 95% CI 1.14-1.42 in heating; 1.26, 1.13-1.40 in cooking). Longer duration of household air pollution exposure (1.47, 1.28-1.68 in heating; 1.36, 1.19-1.56 in cooking) and household air pollution from crop residue/wood burning (1.66, 1.41-1.94 in heating; 1.37, 1.23-1.53 in cooking) was correlated with higher depression risk. For subgroups analysis, the effect of household air pollution from solid fuel on depression varied. Compared with those who using clean fuel, older adults living in small size houses or houses with small number rooms had increasing depression risks if they used solid fuel for heating or cooking. Our findings indicate long-term household air pollution exposure from solid fuel use is associated with higher depression risk. Reducing household air pollution by restricting solid fuel use can be effective ways to prevent depression for Chinese older adults and decrease related public health burden.