Environment/Climate Change
Impact of the coal-to-clean energy policy on blood pressure in peri-urban adults in Beijing, China. Talia Sternbach* Talia Sternbach Xiaoying Li Xiang Zhang Ellison Carter Brian Robinson Chris Barrington-Leigh Guofeng Shen Wenlu Yuan Collin Brehmer Kaibing Xue Kennedy Hirst Shu Tao Yuanxun Zhang Sam Harper Jill Baumgartner
Household solid fuel use in China was responsible for an estimated 363,000 deaths in 2019, including 227,000 cardiovascular deaths. In 2013, the Chinese government launched a multi-city coal-to-clean energy policy designed to reduce household solid fuel emissions and improve air quality. The policy banned household coal burning and provided subsidies for electric or gas-powered heating. We took advantage of the staggered implementation of the ban across villages in peri-urban Beijing to investigate whether the policy impacted blood pressure (BP).
In winter 2018-19, we enrolled 1,003 participants in 50 Beijing villages that were eligible for but not enrolled into the policy and conducted follow-up campaigns in winter 2019-20 and 2021-22. Twenty of our 50 study villages were enrolled into the policy during the study (10, 7, and 3 villages in 2019, 2020, and 2021, respectively). Questionnaires and BP measurements were conducted by trained staff during household visits in each campaign. Brachial and central BPs were measured using an automated oscillometric device. We estimated the policy’s impact on BP using a staggered difference-in-differences design with extended-two-way fixed effects estimators and village-level clustered standard errors. We also adjusted for age, sex, waist circumference, smoking, alcohol consumption, and high BP medication to improve precision.
Average treatment effects on the treated showed some evidence that the policy reduced systolic BP (-1.3 mmHg, 95% CI: -3.2 to 0.6), diastolic BP (-1.6 mmHg, 95% CI: -2.9 to -0.2), and central pulse pressure (-1.6 mmHg, 95% CI: -3.0 to -0.2). Diastolic BP reductions were more precise than those for systolic, and BP reductions were greater in villages treated in 2019 compared with those treated later. Clean energy policies that reduce harmful exposures may serve as a population-level intervention for BP in China to supplement higher-risk BP reduction strategies and behavioral modifications.