Historical U.S. Residential Coal Use and Female Lung Cancer Mortality

Abstract

Recent ecological and case-control studies have indicated elevated lung cancer mortality (LCM) associated with bituminous “smoky” coal (BC) use in China, but no similar study has been conducted using U.S. populations. Early-to-mid 20^th century U.S. county-level consumption of BC for home heating was examined in relation to age-specific LCM, focusing on mortality in white women aged 40+ vs. 60+ years (among whom ∼11% vs. ∼5% ever smoked, respectively) during 1950 to 1954. To limit potential confounding due to variations in housing characteristics associated with counties where most vs. few homes used coal for heating, this study focused on domestic BC consumption only in 640 counties in which >75% of homes used coal for heating in 1940. County-level data on domestic net tons of BC consumed per capita for the year 1918 were used to estimate lifetime residential exposure to BC smoke, and analyses focused on a 539-county subset for which estimated BC use remained fairly constant between 1918 and 1940. Significantly positive ecological associations were found between BC use and LCM risk in U.S. white women dying in 1950 to 1954 at age 40+ or 60+ y, after adjusting for age and combinations of 20 socio-demographic/geoclimatic variates. The apparent associations suggest that lifetime exposure to residential BC-combustion smoke may have increased LCM risk by about 25% to 50% among relatively highly exposed U.S. women. While these results must viewed in the context of the inherent limitations of any ecological study design, their consistency with results from studies on Chinese women suggests that some risk reduction might be achieved by increased (or universal) application of inexpensive measures to reduce or eliminate any indoor coal smoke in U.S. homes.

Keywords:

• bituminous coal
• ecological design
• epidemiology
• fuel
• smoke
• smoking.