Estimating household air pollution exposures and health impacts from space heating in rural China

Exposure to and the related burden of diseases caused by pollution from solid fuel cooking, known as household air pollution (HAP), has been incorporated in the assessment of the Global Burden of Diseases (GBD) project. In contrast, HAP from space heating using solid fuels, prevalent in countries at middle or high altitudes, is less studied and missing from the GBD assessment. China is an ideal example to estimate the bias of exposure and burden of diseases assessment when space heating is neglected, considering its remarkably changing demands for heating from the north to the south and a large solid-fuel-dependent rural population. In this study, based on a meta-analysis of 27 field measurement studies in rural China, we derive the indoor PM_2.5 (fine particulate matter with an aerodynamic diameter smaller than 2.5 μm) concentration for both the heating and non-heating seasons. Combining this dataset with time-activity patterns and percentage of households using solid fuels, we assess the population-weighted annual mean exposure to PM_2.5 (PWE) and the health impacts associated with HAP in mainland rural China by county for the year 2010. We find that ignoring heating impacts leads to an underestimation in PWE estimates by 38 μg/m³ for the nationwide rural population (16 to 40 as interquartile range) with substantial negative bias in northern provinces. Correspondingly, premature deaths and disability-adjusted life years will be underestimated by approximately 30 × 10³ and 60 × 10⁴ in 2010, respectively. Our study poses the need for incorporating heating effects into HAP risk assessments in China as well as globally.