Date of Award

January 2020

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)


School of Public Health

First Advisor

Zeyan Liew


Background: Sleep disorders are a common public health issue in an aging society. Outdoor air pollution has been linked to poor sleep quality, but few studies have investigated the relationship between indoor air pollution derived from solid fuel combustion and sleep quality in elderly.

Objective: To evaluate the association between indoor air pollution due to cooking solid fuels and sleep quality among adults aged 45 years and elderly in China.

Methods: We analyzed data from the China Health and Retirement Survey (CHARLS), a national survey of ~17,000 residents aged over 45 from 150 counties/districts in China. Participants were restricted to those who completed waves of CHARLS in 2011, 2013, and 2015 (n=8,668). Sleep quality was indicated by self-reported average sleep duration (hours/night) and the numbers of restless days in per week in the 2015 survey. Participants also reported household cooking fuel type in all three surveys. We compared the “solid fuels”, primarily including coal, crop residue or wood burning, with the “clean fuels” including electric, natural gas, and liquefied petroleum gas as the reference. We also evaluated the years of solid fuel use (0, 1-4 or ≥5 years). We used multinomial logistic regression and estimated the odd ratios (OR) and 95% confidence interval (CI) for sleep duration (7-9 hours/night as the reference) and restless sleep (0 day as the reference) according to fuel types adjusting for potential confounding factors.

Results: Solid fuels use for 5 or more years was associated with a shorter duration of sleep (OR=1.17 95% CI 1.01, 1.35 for less than ≤6 hours/day) and higher frequencies of restless days of sleep (OR=1.33 95%CI 1.13, 1.56 for ≥more than 5 days/week) compared with clean fuels users. The associations were in the similar direction but smaller in magnitude for solid fuels use in 1-4 years.

Conclusions: Primary cooking fuel was associated with poor sleep quality in an elderly Chinese population. Further research is needed to evaluate of the specific type of fuels and indoor air pollutants to inform intervention strategies.


This is an Open Access Thesis.

Open Access

This Article is Open Access