Exposure to household air pollution from polluting domestic fuel (solid fuel and kerosene) represents a substantial global public health burden and there is an urgent need for rapid transition to clean domestic fuels. Gas for cooking and heating might possibly affect child asthma, wheezing, and respiratory health. The aim of this review was to synthesise the evidence on the health effects of gaseous fuels to inform policies for scalable clean household energy. In this systematic review and meta-analysis, we summarised the health effects from cooking or heating with gas compared with polluting fuels (eg, wood or charcoal) and clean energy (eg, electricity and solar energy). We searched PubMed, Scopus, Web of Science, MEDLINE, Cochrane Library (CENTRAL), Environment Complete, GreenFile, Google Scholar, Wanfang DATA, and CNKI for articles published between Dec 16, 2020, and Feb 6, 2021. Studies eligible for inclusion had to compare gas for cooking or heating with polluting fuels (eg, wood or charcoal) or clean energy (eg, electricity or solar energy) and present data for health outcomes in general populations. Studies that reported health outcomes that were exacerbations of existing underlying conditions were excluded. Several of our reviewers were involved in screening studies, data extraction, and quality assessment (including risk of bias) of included studies; 20% of studies were independently screened, extracted and quality assessed by another reviewer. Disagreements were reconciled through discussion with the wider review team. Included studies were appraised for quality using the Liverpool Quality Assessment Tools. Key health outcomes were grouped for meta-analysis and analysed using Cochrane's RevMan software. Primary outcomes were health effects (eg, acute lower respiratory infections) and secondary outcomes were health symptoms (eg, respiratory symptoms such as wheeze, cough, or breathlessness). This study is registered with PROSPERO, CRD42021227092. 116 studies were included in the meta-analysis (two [2%] randomised controlled trials, 13 [11%] case-control studies, 23 [20%] cohort studies, and 78 [67%] cross-sectional studies), contributing 215 effect estimates for five grouped health outcomes. Compared with polluting fuels, use of gas significantly lowered the risk of pneumonia (OR 0·54, 95% CI 0·38–0·77; p=0·00080), wheeze (OR 0·42, 0·30–0·59; p<0·0001), cough (OR 0·44, 0·32–0·62; p<0·0001), breathlessness (OR 0·40, 0·21–0·76; p=0·0052), chronic obstructive pulmonary disease (OR 0·37, 0·23–0·60; p<0·0001), bronchitis (OR 0·60, 0·43–0·82; p=0·0015), pulmonary function deficit (OR 0·27, 0·17–0·44; p<0·0001), severe respiratory illness or death (OR 0·27, 0·11–0·63; p=0·0024), preterm birth (OR 0·66, 0·45–0·97; p=0·033), and low birth weight (OR 0·70, 0·53–0·93; p=0·015). Non-statistically significant effects were observed for asthma in children (OR 1·04, 0·70–1·55; p=0·84), asthma in adults (OR 0·65, 0·43–1·00; p=0·052), and small for gestational age (OR 1·04, 0·89–1·21; p=0·62). Compared with electricity, use of gas significantly increased risk of pneumonia (OR 1·26, 1·03–1·53; p=0·025) and chronic obstructive pulmonary disease (OR 1·15, 1·06–1·25; p=0·0011), although smaller non-significant effects were observed for higher-quality studies. In addition, a small increased risk of asthma in children was not significant (OR 1·09, 0·99–1·19; p=0·071) and no significant associations were found for adult asthma, wheeze, cough, and breathlessness (p>0·05). A significant decreased risk of bronchitis was observed (OR 0·87, 0·81–0·93; p<0·0001). Switching from polluting fuels to gaseous household fuels could lower health risk and associated morbidity and mortality in resource-poor countries where reliance on polluting fuels is greatest. Although gas fuel use was associated with a slightly higher risk for some health outcomes compared with electricity, gas is an important transitional option for health in countries where access to reliable electricity supply for cooking or heating is not feasible in the near term. WHO.

中文翻译：

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高收入、中等收入和低收入国家家庭使用气体燃料做饭和取暖对健康的影响估计：系统评价和荟萃分析

受到污染性家用燃料（固体燃料和煤油）造成的家庭空气污染是全球公共卫生的巨大负担，迫切需要迅速过渡到清洁的家用燃料。用于烹饪和取暖的天然气可能会影响儿童哮喘、喘息和呼吸系统健康。本次审查的目的是综合有关气体燃料对健康影响的证据，为可扩展的清洁家庭能源政策提供信息。在这项系统回顾和荟萃分析中，我们总结了与污染燃料（例如木材或木炭）和清洁能源（例如电力和太阳能）相比，使用燃气烹饪或取暖对健康的影响。我们检索了PubMed、Scopus、Web of Science、MEDLINE、Cochrane Library (CENTRAL)、Environment Complete、GreenFile、Google Scholar、万方数据和CNKI，查找2020年12月16日至2021年2月6日期间发表的文章。符合纳入条件的研究必须将用于烹饪或取暖的天然气与污染燃料（例如木材或木炭）或清洁能源（例如电力或太阳能）进行比较，并提供一般人群健康结果的数据。报告健康结果是现有基础疾病恶化的研究被排除在外。我们的几位审稿人参与了纳入研究的筛选研究、数据提取和质量评估（包括偏倚风险）； 20% 的研究由另一位评审员独立筛选、提取和质量评估。通过与更广泛的审查小组的讨论来调和分歧。使用利物浦质量评估工具对纳入的研究进行质量评估。对关键健康结果进行分组进行荟萃分析，并使用 Cochrane 的 RevMan 软件进行分析。主要结局是健康影响（例如，急性下呼吸道感染），次要结局是健康症状（例如，喘息、咳嗽或呼吸困难等呼吸道症状）。本研究已在 PROSPERO 注册，CRD42021227092。荟萃分析纳入了 116 项研究（两项 [2%] 随机对照试验、13 项 [11%] 病例对照研究、23 项 [20%] 队列研究和 78 项 [67%] 横断面研究）， 215 对五组健康结果的效果估计。与污染燃料相比，使用天然气显着降低肺炎（OR 0·54，95% CI 0·38–0·77；p=0·00080）、喘息（OR 0·42，0·30–0）的风险·59；p<0·0001)、咳嗽（OR 0·44、0·32–0·62；p<0·0001）、呼吸困难（OR 0·40、0·21–0·76；p=0 ·0052)、慢性阻塞性肺病（OR 0·37、0·23–0·60；p<0·0001）、支气管炎（OR 0·60、0·43–0·82；p=0·0015） ，肺功能缺陷（OR 0·27、0·17–0·44；p<0·0001）、严重呼吸系统疾病或死亡（OR 0·27、0·11–0·63；p=0·0024） 、早产（OR 0·66、0·45–0·97；p=0·033）和低出生体重（OR 0·70、0·53–0·93；p=0·015）。对儿童哮喘（OR 1·04、0·70–1·55；p=0·84）和成人哮喘（OR 0·65、0·43–1·00；p =0·052),且小于胎龄（OR 1·04、0·89–1·21；p=0·62）。与电力相比，使用燃气显着增加肺炎（OR 1·26、1·03–1·53；p=0·025）和慢性阻塞性肺疾病（OR 1·15、1·06–1·25）的风险; p=0·0011），尽管对于更高质量的研究观察到较小的非显着影响。此外，儿童哮喘风险的小幅增加并不显着（OR 1·09、0·99–1·19；p=0·071），并且未发现与成人哮喘、喘息、咳嗽和呼吸困难有显着关联(p>0·05)。观察到支气管炎的风险显着降低（OR 0·87、0·81–0·93；p<0·0001）。在对污染燃料依赖程度最高的资源贫乏国家，从污染性燃料转向气态家用燃料可以降低健康风险以及相关的发病率和死亡率。尽管与电力相比，使用天然气燃料与某些健康结果的风险稍高有关，但对于短期内无法获得可靠的烹饪或取暖电力供应的国家来说，天然气是健康的重要过渡选择。 WHO。