Effect of exposure to biomass smoke from cooking fuel types and eye disorders in women from hilly and plain regions of Nepal

Changing Trends in the Global Burden of Cataract Over the Past 30 Years: Retrospective Data Analysis of the Global Burden of Disease Study 2019

BACKGROUND

Cataracts now account for the largest proportion of the global burden of blindness and vision loss. Understanding the changing trends in the global burden of cataracts over the past 30 years and the next 15 years is of clear significance for the prevention and control of cataracts in key populations. As far as we know, research on the future burden of cataracts is lacking.

OBJECTIVE

This study aims to assess the global burden of cataracts over the past 30 years by using age-period-cohort modeling and to estimate trends in the next 15 years.

METHODS

Data were obtained from the Global Burden of Disease Study 2019, the United Nations Development Programme, and the WHO (World Health Organization) Global Health Observatory data repository. The assessment of trends and disparities in the number and rate of disability-adjusted life years (DALYs) for cataracts from 1990 to 2019 was conducted. The association between the age-standardized DALY rate (ASDR) and the socio-demographic index (SDI), human development index (HDI), national levels of particulate matter <2.5 μm in diameter (PM2.5), and ambient ultraviolet radiation (UVR) was determined using linear regression analysis. Additionally, we used the Nordpred (Harald Fekjær and Bjørn Møller) age-period-cohort model to predict the cataract burden from 2020 to 2034.

RESULTS

Globally, the number of DALYs due to cataract increased from 3,492,604 (95% uncertainty interval [UI] 2,481,846-4,719,629) in 1990 to 6,676,281 (95% UI 4,761,210-9,006,193) in 2019. The ASDRs due to cataract decreased from 93.17 (95% UI 66.14-125.32) in 1990 to 82.94 (95% UI 59.06-111.75) in 2019, with an average annual percentage change of -0.37 (95% CI -0.44 to -0.3; P<.001). Age, female sex, air pollution, smoking, high fasting plasma glucose levels, and a high body mass index were risk factors for the burden of cataracts. SDI and HDI were negatively correlated with ASDRs of cataracts, while PM2.5 and UVR were positively associated with them. Higher DALY rates were also associated with lower SDI (R2=0.1939; P<.001), lower HDI (R2=0.2828; P<.001), national PM2.5 concentration (R2=0.1874; P<.001), and ambient UVR levels (R2=0.2354; P<.001). The prediction model suggested that the number of DALYs due to cataract will continue to rise globally, while the cataract DALY rate will continue to decrease.

CONCLUSIONS

While the ASDR of cataracts has decreased, there has been a notable increase in the number of DALYs over the past 30 years. Projections suggest that the global burden of cataracts will continue to rise over the next 15 years. To address this challenge, appropriate prevention and treatment policies must be implemented.

Risk factors associated with elevated intraocular pressure: a population-based study in a rural community of Bangladesh

OBJECTIVE

High intraocular pressure (IOP) is one of the major modifiable risk factors for glaucoma. The objective was to examine socio-demographic and clinical factors related to IOP.

METHODS AND ANALYSIS

This study was conducted among 3097 adults residing in a rural area of Bangladesh, with all participants undergoing clinical and ophthalmological evaluations. The measurement of IOP was carried out using of a rebound Tonometer called Icare pro. Multiple logistic regression analysis was employed to identify variables associated to IOP levels of 21 mm Hg or above. Adjusted OR (aOR) and 95% CI were reported.

RESULTS

This study found that, in total, 9% of the study population had high IOP in one or both eyes. Elevated IOP was significantly associated with respondents who were service holders (aOR 2.52; 95% CI 1.48 to 4.31), had a lower education level (aOR 1.55, 95% CI 1.07 to 2.23), used biomass fuel (aOR 2.00; 95% CI 1.09 to 3.67), belonged to a higher socioeconomic position (aOR 1.55, 95% CI 1.07 to 2.23) and had obesity (aOR 2.00; 95% CI 1.07 to 3.73), hypertension (aOR 1.32; 95% CI 1.01 to 1.73) or history of diabetes (aOR 2.44; 95% CI 1.67 to 3.55), after adjusting for covariates including age, sex, marital status, light source and tobacco consumption, in a multiple regression analysis.

CONCLUSION

Chronic diseases, such as hypertension and diabetes, obesity and sociodemographic characteristics such as high socioeconomic status and use of biomass fuels, have all been linked to elevated IOP. Patients with chronic diseases should undergo for IOP testing regularly.

The Association Between Solid Fuel Use and Visual Impairment Among Middle-Aged and Older Chinese Adults: Nationwide Population-Based Cohort Study

BACKGROUND

Indoor air pollution has been reported to have adverse effects on the eye; however, the health effects of exposure to cooking with solid fuels on visual impairment remain unclear in China.

OBJECTIVE

We aimed to examine the association between cooking with solid fuels and visual impairment, including distance visual impairment (DVI) and near visual impairment (NVI).

METHODS

Data were obtained from the China Health and Retirement Longitudinal Study, a nationwide survey of adults aged over 45 years who were enrolled in 2011 (Wave 1) and followed up in Wave 2 (2013), Wave 3 (2015), and Wave 4 (2018). We used Cox proportional hazards models to determine the association between solid fuels use and visual impairment. Additionally, the impact of switching cooking fuel types on vision function were examined through wave-specific data analysis (Wave 1 and Wave 4). Interaction and subgroup analyses were performed to explore the potential effect modifiers. Data were collected using the stratified multistage random sampling method and further analyzed using SPSS 27.0 and R 4.2.1 statistical software packages.

RESULTS

A total of 9559 middle-aged and older Chinese adults without visual impairment at baseline were included in the study, with 51.2% (n=4914) of the participants reporting that they cooked with solid fuels. During the follow-up period, 2644 (27.5%) and 3130 (32.6%) participants developed DVI and NVI, respectively. Compared with the clean fuel users, participants who cooked with solid fuels had a higher risk of DVI (hazards ratio [HR] 1.38, 95% CI 1.28-1.50) and NVI (HR 1.18, 95% CI 1.10-1.27). In addition, switching the cooking fuel type from clean to solid fuels was associated with an elevated risk of DVI (HR 1.51, 95% CI 1.15-1.98) and NVI (HR 1.39, 95% CI 1.06-1.82) compared to persistently using clean fuels during the follow-up period, although no protective effect of switching from solid to clean fuels on NVI was found (P=.52). In subgroup analysis, we found that cooking with solid fuels increased the risk of DVI in participants younger than 65 years (HR 1.41, 95% CI 1.28-1.55), men (HR 1.45, 95% CI 1.28-1.65), urban residents (HR 1.41, 95% CI 1.08-1.75), and smokers (HR 1.43, 95% CI 1.25-1.64). By contrast, negative effects of cooking with solid fuels on NVI were found in nonsmokers (HR 1.21, 95% CI 1.11-1.33) and urban residents (HR 1.20, 95% CI 1.10-1.37).

CONCLUSIONS

Cooking with solid fuels was associated with an increased risk of visual impairment among middle-aged and older Chinese adults. These findings indicate that promoting the utilization of clean fuels is conducive to reducing the burden of visual impairment for the public.

Impact of air pollution on human health in different geographical locations of Nepal

According to a recent survey, Nepal's urban air quality has been classified as one of the worst in the globe. A large portion of the country's population is subjected to health risks caused by air pollution. As Nepal has a wide variation in altitude coupled with socio-cultural and biological diversities, it is important to understand the different health hazards in the different geographical regions - Terai, Hills and Mountains. Constantly increasing physical infrastructures (such as transport vehicles, open burning of plastics and other fuels) are the main reasons for the escalating air pollution in the country. This study aims to critically review the current air pollution status in different geographical locations along with its impacts on public health in the country. It has been revealed that irrespective of geographic location, the air pollutants interfere with different human physiological systems related to respiration as well as cardiovascular, ophthalmic, and gastrointestinal functioning. Further, the research findings highlighting the influence of prolonged exposure of the population to the air pollution leading to the significant number of deaths have been presented. A notable rise in the number of hospitalized patients suffering from illnesses related to above mentioned pollution borne cases has been reported.

Association of biomass fuel use with the risk of vision impairment among Chinese older adults: a cohort study

Cooking with biomass fuels has been reported to have adverse effects on health. This study aims to explore the association between cooking with biomass fuels and vision impairment among Chinese older adults aged 65 years and above. This cohort study drew on data from the 2011/2012 wave and the 2014 follow-up wave of the Chinese Longitudinal Healthy Longevity Survey. Participants' visual function was examined through a vision screening test. Exposure to indoor biomass fuels was self-reported. Cox proportional hazards models were applied to explore the relationship between biomass fuel use and vision impairment. Additionally, we compared the risk of vision impairment between participants who switched cooking fuel types and those who did not. Subgroup and interaction analyses were conducted to explore the potential effect modifiers. A total of 4711 participants were included in this study. During the follow-up, 1053 (22.35%) participants developed vision impairment. Cooking with biomass fuels increased the risk of vision impairment by 40% (hazard ratio [HR]: 1.40, 95% confidence interval [CI]: 1.21-1.61). Participants who switched from clean fuels to biomass fuels had a greater risk of vision impairment than persistent clean fuel users (HR: 1.44, 95% CI: 1.03-2.00). Greater effect estimates were found in participants who lived in eastern and central China and urban residents. Cooking with biomass fuels resulted in a greater risk of vision impairment among Chinese older adults. This risk also existed in those who changed their cooking fuels from clean fuels to biomass fuels. Further studies with an objective assessment of biomass fuel combustion are required to confirm our findings.

Biomass using tribal women exhibited respiratory symptoms, hypertensive risks and abnormal pulmonary function

In rural areas of developing countries, solid fuels are still widely used for cooking, heating, and lighting purposes. This study investigates the effects of household air pollutants (HAPs) exposure on the occurrence of respiratory symptoms, blood pressure, and lung function. In this study, we randomly selected 123 (83 biomass and 40 clean fuel user) subjects to assess the impact of smoke generated from solid biomass fuel by assessing their health status along with the ventilation pattern of the kitchens and living rooms. HAPs (PM10, PM2.5, and CO) and different health parameters were measured along with monitoring of self-reported health symptoms for a consecutive period of eight months. Results revealed that the concentration of CO, PM2.5, and PM10 were found highest in biomass using households. Higher odds of the upper respiratory symptoms, runny nose (OR: 4.08, 95% CI: 1.22-22.14, p < 0.03), nasal congestion (OR: 9.07, 95% CI: 1.39-97.89, p < 0.01) and the odds of the lower respiratory symptoms like wheezing (OR: 1.62, 95% CI: 1.23-10.94, p < 0.01), breathlessness (OR: 4.44, 95% CI: 1.3-14.75, p < 0.01), chest tightness (OR: 4.89, 95% CI: 1.23-22.14, p < 0.03) and dry cough (OR: 3.661, 95% CI: 1.05-12.25, p < 0.04) were significantly higher in biomass fuel user. Similarly higher systolic (+11.41 mmHg), higher diastolic pressure (+3.3 mmHg), higher pulse pressure (+8.11 mmHg), and a 6 mmHg higher mean arterial pressure among biomass fuel using tribal women. The risk of hypertension was significantly (p < 0.03) higher (OR: 3.04; 95% CI: 1.18-7.89) among solid biomass fuel users. The lung abnormality was recorded 28.91% (OR: 5.02, 95% CI: 1.50 to 16.56, p < 0.01) among biomass fuel user. Finally, it is suggested that the use of efficient cookstoves, increase in cross ventilation, and cleaner fuel are urgently needed to curb the pollution load.

Indoor air pollution and human ocular diseases: Associated contaminants and underlying pathological mechanisms

People spend a long time indoors, especially young children. The risk of indoor pollution on human health is one of the current hotspots in environmental and public health. The human ocular surface is highly susceptible to indoor environment quality. Epidemiological data have linked human ophthalmological disorders with exposure to indoor pollution. In this review, we summarized the adverse impacts of indoor pollution on the human ocular surface. Several studies demonstrated that indoor contaminants including particulate matter, volatile/semi-volatile organic compounds, heavy metals, and fuel combustion and cigarette smoke exposure were associated with the incidence of human dry eye, conjunctivitis, glaucoma, cataracts, age-related macular degeneration, and keratitis. In addition, toxicological investigations revealed that indoor pollution-induced induced chronic inflammation, oxidative damage, and disruption of tight junctions are the main underlying pathological mechanisms for ocular surface diseases. Taken together, this review may expand the understanding of pollution-induced eye disorder and highlight the importance of reducing associated contaminants to decrease their detrimental effects on human eyes.

Smoke and the eyes: A review of the harmful effects of wildfire smoke and air pollution on the ocular surface

Wildfires are occurring worldwide with greater frequency and intensity. Wildfires, as well as other sources of air pollution including environmental tobacco smoke, household biomass combustion, agricultural burning, and vehicular emissions, release large amounts of toxic substances into the atmosphere. The ocular surface is constantly exposed to the ambient air and is hence vulnerable to damage from air pollutants. This review describes the detrimental effects of wildfire smoke and air pollution on the ocular surface and resultant signs and symptoms. The latest relevant evidence is synthesised and critically evaluated. A mechanism for the pathophysiology of ocular surface damage will be proposed considering the existing literature on respiratory effects of air pollution. Current strategies to reduce human exposure to air pollutants are discussed and specific possible approaches to protect the ocular surface and manage air pollution induced ocular surface damage are suggested. Further avenues of research are suggested to understand how acute and chronic air pollution exposure affects the ocular surface including the short and long-term implications.

Relationship between cooking fuel and lens opacities in South India: a 15-year prospective cohort study

PURPOSE

Unclean cooking fuels such as wood and kerosene have been associated with cataract in cross-sectional studies. This study sought to determine whether exposure to unclean cooking fuels was associated with subsequent cataract progression.

DESIGN

Prospective cohort study.

METHODS

This is a secondary observational analysis of the community-based Antioxidants in Prevention of Cataracts trial (ClinicalTrials.gov ID NCT01664819). The exposure of interest was cooking fuel type, measured at baseline. Main outcome measures were baseline cataract severity and self-reported cataract surgery at a 15-year visit.

RESULTS

Baseline and 15-year follow-up data were available for 798 and 579 participants, respectively. Wood or kerosene was used by 711/798 (89.1%) baseline participants, including 539/579 (93.1%) participants with complete follow-up. Cooking fuel type was not associated with cataract severity at baseline (p=0.443). Out of 8,334 person-years of follow up, 90 cataract surgeries were observed over 15 years (1.08 surgeries per 100 person-years; 95%CI 0.87-1.32). Use of wood or kerosene was not associated with 15-year incidence of cataract surgery relative to individuals using propane (adjusted p=0.154). Cataract surgery was more common in older individuals (HR 1.1 per year, 95%CI 1.1-1.2, p<0.001), those with baseline myopia (HR 2.1, 95%CI 1.2-3.5, p=0.009) and women (HR 3.5, 95%CI 1.2 to 10.1, p=0.019).

CONCLUSIONS

This study found no association between unclean cooking fuels and cataract progression over a 15-year period. No other modifiable risk factors were associated with incident self-reported cataract surgery.