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Background <p>Emerging evidence suggests indoor air pollution (IAP) from solid fuel use may adversely affect early childhood development (ECD), yet urban-rural disparities in these associations are not well characterized, particularly in high-altitude regions. This study investigated the disparate effects of solid cooking and heating fuel exposure on ECD across urban and rural communities in Tibet, China.</p> Methods <p>We conducted a cross-sectional analysis of 1,085 children from the Tibetan plateau. IAP exposure was determined through validated questionnaires, while ECD was assessed using the Chinese version of the Age and Stage Questionnaires, Third Edition (ASQ-3). Multivariable logistic regression models evaluated associations between IAP exposure and developmental outcomes, with urban-rural effect heterogeneity examined through interaction tests.</p> Results <p>Solid cooking fuel exposure was significantly associated with developmental delays, particularly in fine motor (OR = 2.25, 95% CI: 1.42–3.56) and communication skills (OR = 2.21, 95% CI: 1.29–3.76). Whereas solid heating fuels showed no overall effect, they specifically impaired fine motor (OR = 3.45, 95% CI: 1.54–7.69) and problem-solving abilities (OR = 2.22, 95% CI: 1.26–3.90). Most notably, combined exposure exhibited a synergistic effect, with the risk of fine motor impairment escalating markedly (OR = 6.27, 95% CI: 2.34–16.84). Furthermore, this association was significantly modified by residential location, being more pronounced in rural (OR = 1.81, 95% CI: 1.28–2.56) than in urban children (OR = 0.70, 95% CI: 0.32–1.54; <i>P</i> for difference &lt; 0.05).</p> Conclusions <p>Household solid fuel use for cooking and heating is associated with domain-specific developmental delays, with effects most pronounced in rural communities. These findings underscore the critical need for targeted interventions to transition to cleaner household energy sources in high-altitude regions, which is essential to safeguard early child development.</p>

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Urban-rural heterogeneity in the association of indoor air pollution exposure with early childhood development among children aged 0–5 years in a Chinese plateau area

  • 期刊论文

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  • 发表日期：

    2025年12月17日

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  • Yajie Li,
  • Bin Yu,
  • Zhuhong Cui,
  • Guoxia Bai,
  • Li Yin,
  • Xianzhi Li

摘要

Background

Emerging evidence suggests indoor air pollution (IAP) from solid fuel use may adversely affect early childhood development (ECD), yet urban-rural disparities in these associations are not well characterized, particularly in high-altitude regions. This study investigated the disparate effects of solid cooking and heating fuel exposure on ECD across urban and rural communities in Tibet, China.

Methods

We conducted a cross-sectional analysis of 1,085 children from the Tibetan plateau. IAP exposure was determined through validated questionnaires, while ECD was assessed using the Chinese version of the Age and Stage Questionnaires, Third Edition (ASQ-3). Multivariable logistic regression models evaluated associations between IAP exposure and developmental outcomes, with urban-rural effect heterogeneity examined through interaction tests.

Results

Solid cooking fuel exposure was significantly associated with developmental delays, particularly in fine motor (OR = 2.25, 95% CI: 1.42–3.56) and communication skills (OR = 2.21, 95% CI: 1.29–3.76). Whereas solid heating fuels showed no overall effect, they specifically impaired fine motor (OR = 3.45, 95% CI: 1.54–7.69) and problem-solving abilities (OR = 2.22, 95% CI: 1.26–3.90). Most notably, combined exposure exhibited a synergistic effect, with the risk of fine motor impairment escalating markedly (OR = 6.27, 95% CI: 2.34–16.84). Furthermore, this association was significantly modified by residential location, being more pronounced in rural (OR = 1.81, 95% CI: 1.28–2.56) than in urban children (OR = 0.70, 95% CI: 0.32–1.54; P for difference < 0.05).

Conclusions

Household solid fuel use for cooking and heating is associated with domain-specific developmental delays, with effects most pronounced in rural communities. These findings underscore the critical need for targeted interventions to transition to cleaner household energy sources in high-altitude regions, which is essential to safeguard early child development.