Background: Large-scale residential energy transitions from solid fuel to clean energy are promising strategies to mitigate climate change and improve population health, but rigorous evaluation of their impacts is rare. We evaluated the impact of China’s Clean Heating Policy (CHP), which aimed to transition tens of millions of households from coal to electric and gas-based space heating, on blood pressure (BP). Methods: In winter 2018-19, we enrolled 1,003 adults aged >40 years from 50 Beijing villages not yet enrolled in the CHP; 20 villages were treated during follow-up (winters 2019-20 and 2021-22). Brachial and central BP and covariates were measured during household visits by trained staff. Policy impacts were estimated using an extended two-way fixed-effects difference-in-differences approach with village-clustered standard errors and adjustment for key BP predictors to improve precision. Findings: We found evidence of reductions (in mmHg) in brachial systolic BP (-1.4, 95% confidence interval [CI]: -3.3, 0.5), central systolic BP (-1.5, 95%CI: -3.3, 0.4), brachial diastolic BP (-1.6, 95%CI: -2.9, -0.3), and central diastolic BP (-1.6, 95%CI: -2.9, -0.3). Treatment effects varied by the year of policy enrollment (p for homogeneity = 0.00 to 0.14) with greater BP reductions among participants in earlier-treated villages. Interpretation: Household energy policies like the CHP may serve as effective population-level interventions to reduce BP in China and complement high-risk approaches to BP reduction.

Background: Outdoor and household PM_2.5 are established risk factors for chronic disease and early mortality. In China, high levels of outdoor PM_2.5 and solid fuel use for cooking and heating, especially in winter, pose large health risks to the country’s aging population. Hand grip strength is a validated biomarker of functional aging and strong predictor of disability and mortality in older adults. We investigated the effects of wintertime household and outdoor PM_2.5 on maximum grip strength in a rural cohort in Beijing. Methods: We analyzed data from 877 adults (mean age: 62 y) residing in 50 rural villages over three winter seasons (2018–2019, 2019–2020, and 2021–2022). Outdoor PM_2.5 was continuously measured in all villages, and household (indoor) PM_2.5 was monitored for at least two months in a randomly selected ~30% subsample of homes. Missing data were handled using multiple imputation. We applied multivariable mixed effects regression models to estimate within- and between-individual effects of PM_2.5 on grip strength, adjusting for demographic, behavioral, and health-related covariates. Results: Wintertime household and outdoor PM_2.5 concentrations ranged from 3 to 431 μg/m³ (mean = 80 μg/m³) and 8 to 100 μg/m³ (mean = 49 μg/m³), respectively. The effect of a 10 μg/m³ within-individual increase in household and outdoor PM_2.5 on maximum grip strength was 0.06 kg (95%CI: −0.01, 0.12 kg) and 1.51 kg (95%CI: 1.35, 1.68 kg), respectively. The household PM_2.5 effect attenuated after adjusting for outdoor PM_2.5, while outdoor PM_2.5 effects remained robust across sensitivity analyses. We found little evidence of between-individual effects. Conclusions: We did not find strong evidence of an adverse effect of household PM_2.5 on grip strength. The unexpected positive effects of outdoor PM_2.5 on grip strength may reflect transient physiological changes following short-term exposure. However, these findings should not be interpreted as evidence of protective effects of air pollution on aging. Rather, they highlight the complexity of air pollution’s health impacts and the value of longitudinal data in capturing time-sensitive effects. Further research is needed to better understand these patterns and their implications in high-exposure settings.

Large-scale residential energy transitions from solid fuel to clean energy are promising strategies to mitigate climate change and improve population health, but rigorous evaluation of their impacts is rare. China’s Clean Heating Policy (CHP) aimed to transition tens of millions of households from coal to electric and gas-based space heating. Following evidence of policy-driven improvements in indoor air pollution and indoor temperature, we evaluated the CHP’s impact on blood pressure (BP). In winter 2018–2019, we enrolled 1,003 adults aged >40 years from 50 Beijing villages not yet treated by the CHP; 20 villages were treated during follow-up (winters 2019–2020 and 2021–2022). Brachial and central BP and covariates were measured during household visits by trained staff. Policy impacts were estimated using an extended two-way fixed-effects difference-in-differences approach with village-clustered standard errors and adjustment for key BP predictors to improve precision. We found evidence of reductions (in mmHg) in brachial systolic BP (−1.4, 95% confidence interval [CI]: −3.3, 0.5), central systolic BP (−1.5, 95% CI: −3.3, 0.4), brachial diastolic BP (−1.6, 95% CI: −2.9, −0.3), and central diastolic BP (−1.6, 95% CI: −2.9, −0.3) among villages treated by the CHP compared with those untreated. Treatment effects varied by the year villages were treated by the CHP (p for homogeneity = 0.00 to 0.14) with greater BP reductions among participants in earlier-treated villages. Household energy policies like the CHP may serve as effective population-level interventions to reduce BP in China and complement high-risk cardiovascular prevention strategies.