Research Article Advance Publication
Incense Use and Cardiovascular Mortality among Chinese in Singapore: The Singapore Chinese Health Study
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; 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.
Notice of Intent to RecruitThe National Institute of Environmental Health Sciences will soon announce a search for candidates for the position of Supervisory Technical Editor (Operations Manager) for EHP. The Operations Manager will report directly to the Editor-in-Chief of EHP. To learn more, read the full notice of intent to recruit.
CEHN October 2014 Article of the Month“Maternal Exposure to Criteria Air Pollutants and Congenital Heart Defects in Offspring: Results from the National Birth Defects Prevention Study” (Environ Health Perspect; DOI:10.1289/ehp.1307289) has been selected by the Children’s Environmental Health Network (CEHN) as its October 2014 Article of the Month. These CEHN summaries discuss the potential policy implications of current children’s environmental health research.
Sign Up to Receive E-mail Alerts
Recent Advance Publications
Commuting-Adjusted Short-Term Health Impact Assessment of Airborne Fine Particles with Uncertainty Quantification via Monte Carlo Simulation
Effects of Benzo[a]pyrene Exposure on Human Hepatocellular Carcinoma Cell Angiogenesis, Metastasis, and NF-κB Signaling
Gene-Specific Differential DNA Methylation and Chronic Arsenic Exposure in an Epigenome-Wide Association Study of Adults in Bangladesh
Prenatal Exposure to Maternal Cigarette Smoking and DNA Methylation: Epigenome-Wide Association in a Discovery Sample of Adolescents and Replication in an Independent Cohort at Birth through 17 Years of Age
Human Health Effects of Dichloromethane: Key Findings and Scientific Issues