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Research Article Advance Publication

Environ Health Perspect; DOI:10.1289/ehp.1307662

Incense Use and Cardiovascular Mortality among Chinese in Singapore: The Singapore Chinese Health Study

An Pan,1 Maggie L. Clark,2 Li-Wei Ang,3 Mimi C. Yu,4 Jian-Min Yuan,5,6 and Woon-Puay Koh7,1
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1Swee Hock School of Public Health and Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore; 2Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, Colorado, USA; 3Epidemiology and Disease Control Division, Ministry of Health, Singapore; 4University of Southern California Keck School of Medicine, Los Angeles, California, USA; 5Division of Cancer Control and Population Sciences, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania, USA; 6Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; 7Duke-NUS Graduate Medical School Singapore, Singapore
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This EHP Advance Publication article has been peer-reviewed, revised, and accepted for publication. EHP Advance Publication articles are completely citable using the DOI number assigned to the article. This document will be replaced with the copyedited and formatted version as soon as it is available. Through the DOI number used in the citation, you will be able to access this document at each stage of the publication process.

Citation: Pan A, Clark ML, Ang LW, Yu MC, Yuan JM, Koh WP. Incense Use and Cardiovascular Mortality among Chinese in Singapore: The Singapore Chinese Health Study. Environ Health Perspect;

Received: 17 September 2013
Accepted: 13 August 2014
Advance Publication: 15 August 2014

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Background: Incense burning is common in many parts of the world. Although it is perceived that particulate matter from incense smoke is deleterious to health, there is no epidemiologic evidence linking domestic exposure to cardiovascular mortality.

Objective: We examined this association in the Singapore Chinese Health Study.

Methods: We enrolled a total of 63,257 Singapore Chinese aged 45-74 years during 1993-1998. All participants were interviewed in person to collect information about lifestyle behaviors, including the practice of burning incense at home. We identified cardiovascular deaths via record linkage with the nationwide death registry through December 31, 2011.

Results: In this cohort, 76.9% were current incense users and the majority of current users (89.9%) had burnt incense daily for 20 years and longer. Relative to non-current users, current users had a 12% higher risk of cardiovascular mortality [multivariable adjusted hazard ratio (HR) = 1.12; 95% CI: 1.04, 1.20]. The HR was 1.19 (95% CI: 1.03, 1.37) for mortality due to stroke and 1.10 (95% CI: 1.00, 1.21) for mortality due to coronary heart disease. The association between current incense use and cardiovascular mortality appeared to be limited to participants without a history of cardiovascular disease at baseline (HR = 1.16; 95% CI: 1.07, 1.26) but not those with a history (HR = 1.00; 95% CI: 0.86, 1.17). In addition, the association was stronger in never smokers (HR = 1.12; 95% CI: 1.02, 1.23) and former smokers (HR = 1.19; 95% CI: 1.00, 1.42), than in current smokers (HR = 1.05; 95% CI: 0.91, 1.22).

Conclusions: Long-term exposure to incense burning in the home environment was associated with an increased risk of cardiovascular mortality in the study population.

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