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Cooking and future risk of all-cause and cardiopulmonary mortality

Nature Human Behaviour volume 7, pages 200–210 (2023)Cite this article

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Abstract

Cooking is practiced worldwide and is associated with multiple social, economic and environmental factors; thus, understanding cooking-related health effects would have broad public health implications. Here, we show that after an average 9.9 years of follow-up for 510,106 Chinese adults, always cooking with clean fuels was associated with lower risks of all-cause (0.90 [95% confidence interval 0.87–0.93]; P = 1.39 × 10−9), cardiovascular (0.83 [0.78–0.87]; P = 6.83 × 10−11) and respiratory (0.88 [0.79–0.99]; P = 0.026) mortality compared with non-cooking, of which 50.1% (14.5–85.6%) to 66.0% (38.5–85.8%) could be attributed to increased household physical activity. The mortality risks decreased with extended duration of cooking with clean fuels in dose–response manners, with the lowest hazard ratios of 0.74 (0.68–0.80; P = 1.20 × 10−13) for all-cause and 0.62 (0.55–0.71; P = 3.15 × 10−12) for cardiovascular mortality among never-smokers reported over 25 years of cooking. Our findings suggest lower future mortality risks may be gained only when cooking with clean fuels.

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Fig. 1: Overview and cooking prevalence of the study (n = 512,715).
Fig. 2: Adjusted HRs for all-cause and cardiopulmonary mortality by duration of cooking with clean fuels.
Fig. 3: Association between cooking with clean fuels and all-cause mortality, stratified by baseline characteristics.
Fig. 4: Estimated proportion of association between cooking with clean fuels and risk of all-cause and cardiopulmonary mortality explained by hypothesized mediators.

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Data availability

The authors do not own the data for this study. Data from the baseline survey, first resurvey and cause-specific mortality are available to all bona fide researchers (www.ckbiobank.org). Requests for additional data should be submitted to the (CKB) Data Access Committee (http://www.ckbiobank.org/site/Research/Data+Access+Policy). As stated in the policy, the CKB study group must maintain the integrity of the database for future use and regulate data access to comply with prior conditions agreed with the Chinese government. Data security is an integral part of CKB study protocols. Data can be released outside the CKB research group only with appropriate security safeguards.

Code availability

Analysis code is available at the Open Science Foundation repository at https://osf.io/ej7sd/.

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Acknowledgements

This work, along with two previous publications7,8 from our team, belongs to our project approved by the CKB study group (DAR-00081-CN). The members of the steering committee and collaborative group are listed in the Supplementary Information. This work was supported by grants from the National Natural Science Foundation of China (82192903, 82021005 and 81390540) (T.W.), the Fundamental Research Funds for the Central Universities (2019kfyXMBZ015) (T.W.) and the Consulting Project of Chinese Academy of Engineering (2022-XY-36) (T.W.). The CKB baseline survey and the first resurvey were supported by the Kadoorie Charitable Foundation in Hong Kong. The long-term follow-up has been supported by the UK Wellcome Trust (grant nos 088158/Z/09/Z and 104085/Z/14/Z) (Z.C.) and the National Key Research and Development Program of China (grants 2016YFC0900500, 2016YFC0900501 and 2016YFC0900504) (L.L.) and the Chinese Ministry of Science and Technology (2011BAI09B01) (L.L.). The British Heart Foundation, UK Medical Research Council and Cancer Research provide core funding to the Clinical Trial Service Unit and Epidemiological Studies Unit at Oxford University for the project. The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.

Author information

Author notes

  1. These authors contributed equally: Kuai Yu, Jun Lv, Gang Liu.

  2. These authors jointly supervised this work: Liming Li, Tangchun Wu.

Authors and Affiliations

  1. Department of Occupational and Environmental Health and Department of Epidemiology and Biostatistics, Key Laboratory of Environment and Health, Ministry of Education and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China

    Kuai Yu & Tangchun Wu

  2. Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China

    Jun Lv, Canqing Yu & Liming Li

  3. Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China

    Gang Liu

  4. Chinese Academy of Medical Sciences, Beijing, China

    Yu Guo

  5. Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK

    Ling Yang, Yiping Chen & Zhengming Chen

  6. Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China

    Chaolong Wang

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Contributions

K.Y., L.L. and T.W. had the idea for the study and contributed to study design. Y.G., L.Y. and Y.C. coordinated data acquisition and standardization. K.Y. analysed data. K.Y., J.L., G.L., C.W. and T.W. interpreted data. K.Y. wrote the draft report and all authors contributed to revision of the report. J.L., C.Y., Y.G., L.Y., Z.C. and L.L. provided administrative, technical or material support. Z.C. and L.L. are members of the CKB study steering committee and designed and supervised overall study implementation and obtained funding.

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Correspondence to Liming Li or Tangchun Wu.

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Nature Human Behaviour thanks Takeo Fujiwara, Ho Yu Cheng and Chloe Astbury for their contribution to the peer review of this work.

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List of study committees and investigators, Supplementary Figs. 1–4 and Tables 1–5.

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Yu, K., Lv, J., Liu, G. et al. Cooking and future risk of all-cause and cardiopulmonary mortality. Nat Hum Behav 7, 200–210 (2023). https://doi.org/10.1038/s41562-022-01486-5

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