Switching from coal and wood to electricity or gas for cooking and heating

Cost: Rural households must replace their stoves and pay higher fuel costs, resulting in an annual expense of several hundred to over a thousand yuan. This is a one-time change that doesn’t require ongoing effort. In cities, most households already use electricity or gas.
In plain terms: People who cook with coal or wood face roughly a 10% higher chance of dying over the same period compared to those using electricity or gas. For those who heat their homes with coal or wood, the risk is about 14% higher. Those who have already switched to cleaner fuels have a mortality risk that is 13%–33% lower than those still relying on coal or wood.
Benefit: A Chinese longitudinal study tracked 271,000 adults without cardiovascular disease, recording their health outcomes without assigning them to groups. Individuals who cooked using solid fuels such as coal or wood had a mortality risk roughly 11% higher (HR 1.11) than those using electricity or gas. Those who used solid fuels for heating faced a 14% higher risk (HR 1.14). Among people who had switched from solid fuels to cleaner alternatives, the risk dropped by 13% for cooking (HR 0.87) and by 33% for heating (HR 0.67). Separate data also show that for every 10 µg/m³ increase in long-term exposure to outdoor PM2.5, the risk of death from natural causes rises by roughly 8% (RR 1.08). Natural causes refer to deaths not resulting from accidents.
Evidence grade: A
Sources:Yu K 等 (2018). Association of Solid Fuel Use With Risk of Cardiovascular and All-Cause Mortality in Rural China. JAMA. https://doi.org/10.1001/jama.2018.2151；Chen J, Hoek G (2020). Long-term exposure to PM and all-cause and cause-specific mortality: A systematic review and meta-analysis. Environment International. https://doi.org/10.1016/j.envint.2020.105974
Notes: These studies merely track health outcomes over time. Households that switch to cleaner fuels are often wealthier, so part of the observed 0.67-fold reduction in risk is likely linked to socioeconomic factors. Regarding outdoor PM2.5, individual actions such as relocating, wearing masks, or using air purifiers have limited impact. There are no studies evaluating air purifiers based on mortality rates, so no specific figures are provided here. 〔104〕