The association between solid fuel use for heating and cooking and low back pain and neck pain in middle-aged to elderly Chinese adults: a cross-sectional and panel data analysis

In low - and middle-income countries, a large number of people still use solid fuels, including crop residues such as biofuels/wood and coal, for heating and cooking. Compared with clean fuels(electric, liquefied petroleum gas, natural gas, marsh gas and solar), solid fuels can cause numerous health hazards. There is limited evidence suggesting that the use of solid fuel is associated with self-perceived low back pain (LBP) and neck pain (NP). This study aimed to analyze the association between household solid fuel use and the risk of LBP and NP in middle aged and elderly adults.

We used data from the China Health and Retirement Longitudinal Study for five cross-sectional and ten panel analyses. Multivariable logistic regression model and generalized estimation equation were used to elucidate the relationship between solid fuel and the number of solid fuels used and two pains(LBP and NP). Moreover, the effect of fuel type conversion on LBP and NP is also done.

The results indicate that users of solid fuels, particularly those using solid cooking fuels, may have a higher risk of LBP(OR: 1.13, 95% CI: 1.05-1.22 for 2011-2020) and NP(OR: 1.22, 95% CI: 1.13-1.31 for 2018-2020). The use of solid fuels for heating also raises the risk of LBP(OR: 1.15, 95% CI: 1.06-1.24 for 2011-2020) and NP(OR: 1.34, 95% CI: 1.22-1.46 for 2015-2020). Compared to complete clean fuel users, both mixed fuel and complete solid fuel users face a greater risk for LBP (OR: 1.29, 95% CI: 1.17-1.43 for complete solid fuel users) and NP(OR: 1.38, 95% CI: 1.22-1.55 for complete solid fuel users). Additionally, persistent solid fuel users and those who switch fuel types exhibit higher risks of LBP (OR: 1.33, 95% CI: 1.20-1.47 for persistent solid fuel heating; OR: 1.39, 95% CI: 1.26-1.54 for persistent solid fuel cooking) and NP (OR: 1.38, 95% CI: 1.20-1.59 for persistent solid fuel heating; OR: 1.34, 95% CI: 1.17-1.54 for persistent solid fuel cooking) than persistent clean fuel users.

Long-term exposure to household solid fuels is associated with a higher risk of LBP and NP. It is suggested that multiple departments cooperate to increase the global use of clean energy and thereby reduce the risk of LBP and NP among middle-aged and elderly people.