Cardiovascular disease risk associated with housing disadvantages among middle-aged and older populations in China: a cohort study.

BACKGROUND: Evidence for associations of housing disadvantages with cardiovascular disease (CVD) is scarce. This study aimed to assess the association of housing disadvantages with CVD among middle-aged and older populations in China. METHODS: We conducted analyses by data from China Health and Retirement Longitudinal Study, 2011-2018. CVD events were ascertained by self-reported data. A total of 9,843 individuals were included in stroke sub-cohort, and 8,752 individuals were included in heart disease sub-cohort. Cox regression was used to estimate hazard ratio (95% confidence interval (CI)) of housing disadvantages with CVD. Population attributable fractions were calculated through Levin's formula and Monte-Carlo simulation to estimate the CVD incidence associated with housing disadvantages in China. RESULTS: We found that using crops (HR = 1.35; 95% CI: 1.08-1.68) and coal fuel (HR: 1.71, 95%CI: 1.40-2.10) as heating energy sources were positively associated with heart disease risk compared to clean fuels. Unsafe sanitation was found to be associated with 43% (HR: 1.43, 95%CI: 1.23-1.66) higher heart disease risk and 30% (HR: 1.30, 95%CI: 1.06-1.60) higher stroke risk, and unsafe water source was positively associated with stroke risk (HR: 1.30, 95%CI: 1.08-1.56). Geographical disparities in CVD cases associated with housing disadvantages at a provincial level were found. Annually 1,380,000 cases (15.1%), 718,000 cases (7.9%), and 1,471,000 cases (16.1%) of heart diseases were associated with coal heating energy use, crop heating energy use, and unsafe sanitation, separately. 360,000 cases (12.1%) and 189,000 cases (6.4%) of strokes were associated with unsafe sanitation and unsafe water sources. Regions with lower socio-economic status had higher PAF. CONCLUSIONS: These findings suggested that housing disadvantages were associated with CVD risk in China and highlighted geographical inequality in cardiovascular diseases associated with housing disadvantages.