Cooking and future risk of all-cause and cardiopulmonary mortality

Cooking is practiced worldwide and is associated with multiple social, economic and environmental factors; thus, understanding cooking-related health effects would have broad public health implications. Here, we show that after an average 9.9 years of follow-up for 510,106 Chinese adults, always cooking with clean fuels was associated with lower risks of all-cause (0.90 [95% confidence interval 0.87–0.93]; P = 1.39 × 10−9), cardiovascular (0.83 [0.78–0.87]; P = 6.83 × 10−11) and respiratory (0.88 [0.79–0.99]; P = 0.026) mortality compared with non-cooking, of which 50.1% (14.5–85.6%) to 66.0% (38.5–85.8%) could be attributed to increased household physical activity. The mortality risks decreased with extended duration of cooking with clean fuels in dose–response manners, with the lowest hazard ratios of 0.74 (0.68–0.80; P = 1.20 × 10−13) for all-cause and 0.62 (0.55–0.71; P = 3.15 × 10−12) for cardiovascular mortality among never-smokers reported over 25 years of cooking. Our findings suggest lower future mortality risks may be gained only when cooking with clean fuels.