Abstract
BACKGROUND: The prevalence of dual sensory impairment (DSI), which encompasses both hearing impairment (HI) and vision impairment (VI), exceeds 10% among middle-aged and older populations worldwide. Recently, the impact of environmental factors on DSI has drawn more attention. Limited knowledge exists regarding the impact of household solid fuel use on the prevalence of DSI among Chinese adults. Therefore, the objective of this study is to investigate the implications of household solid fuel utilization on the prevalence of DSI, as well as on individual VI or HI. METHODS: We conducted a retrospective analysis using data from the most recent four waves (2011, 2013, 2015, and 2018) of the China Health and Retirement Longitudinal Study (CHARLS), which started its survey in 2011. Using time-dependent Cox regression, we examined the association between household solid fuel use and the prevalence of DSI. The models included multiplicative interaction terms for stratified analysis, and likelihood-ratio tests were conducted to complete the interaction analysis. Additionally, decision tree models were employed to identify individuals at high risk of DSI. RESULTS: Among the 1,228 respondents, 587 (47.80%) were female, and median age of 55 years. Over a 7-year follow-up period, 774 (68.62%) participants developed DSI. In comparison to individuals who use clean fuel, those who utilize solid fuel for cooking had an elevated risk of DSI (HR = 1.191; 95% CI: 1.018-1.391). Similarly, the risk of HI was 17.7% higher (95% CI: 1.015-1.365) among individuals using solid fuels for cooking compared to those using clean fuels, and 24.9% higher (95% CI: 1.032-1.512) among those using solid fuels for both heating and cooking. Notably, compared to clean fuel users for cooking, solid fuel users for 7 or more years were 1.328 times more likely to develop DSI. We found that the risk of DSI steadily increased with longer duration of solid fuel use (P for trend = 0.008). CONCLUSION: Household solid fuel use increased the risk of DSI and HI for middle-aged and older Chinese adults, suggesting that reducing household solid fuel use and decreasing household air pollution may help prevent the development of sensory impairments.