Research Article Advance Publication
Incense Use and Cardiovascular Mortality among Chinese in Singapore: The Singapore Chinese Health Study
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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; http://dx.doi.org/10.1289/ehp.1307662.
Received: 17 September 2013
Accepted: 13 August 2014
Advance Publication: 15 August 2014
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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