Health Impacts of Energy Transition: Asthma Control Before and After Changing Gas Stoves to Electric Stoves

• In Event: Power, Heat, and Well-Being: Energy Access as a Social Determinant of Health

Abstract

Background: Combustion of natural gas creates nitrogen dioxide (NO2) and other nitrogen oxides which can aggravate symptoms of pre-existing respiratory conditions. Additionally, unburned natural gas (mostly methane) escapes from leaks and incomplete combustion and is a potent greenhouse gas. Previous work on the health effects of gas stoves has been limited to observational studies. We sought to assess asthma control before and after an intervention that involved changing gas stoves to electric stoves and examined indoor air quality and satisfaction with electric stoves.

Methods: We enrolled 85 individuals from 72 households. Households were eligible to participate if i) they used a gas stove for cooking, ii) were located in disadvantaged neighborhoods designated by the United States Environmental Protection Agency (EPA), and iii) at least one person in the household had asthma. Intervention involved capping the natural gas line and removing the natural gas stove, creating a 240-volt electrical outlet to power the new stove, and installing an electric induction stove. The project was selected for three years of funding by the EPA on December 2, 2024. However, the Trump Administration terminated this project on May 2, 2025, limiting our initial target size of 1,200 households.

The primary outcome was change in Asthma Control Questionnaire [ACQ] score from baseline (1-4 weeks before stove change) to follow-up (2-3 months after change). Changes in emergency room visits or hospitalizations for asthma, missed work or school days because of asthma, and indoor air quality (NO2) were also examined. Household satisfaction was asked using a 5-point Likert scale that ranged from very dissatisfied to very satisfied.

A Generalized Estimating Equations approach with an exchangeable working correlation structure was used to account for clustering of individuals within households. Changes in air quality and stove satisfaction were analyzed using the Wilcoxon signed rank test with households as the unit of analysis.

Results: ACQ score improved from 2.6 to 1.5 following the stove change (difference -1.1, 95% confidence interval [CI] -1.3 to -0.8). There were significant reductions in emergency room visits or hospitalization (absolute difference -8.2%, 95% CI -16.2% to -3.4%), and significant improvements in missed work or school because of asthma. Indoor NO2 levels decreased from 21.0 to 6.3 ppb (change -14.7, 95% CI -20.8 to -8.7). There was a 42.6 point (95% CI 31.4 to 53.8) increase in stove satisfaction score.

Conclusion: The 1.1-point improvement in ACQ scores in our study is twice as large as that found with medical treatment. The costs for stove installation and required electrical upgrades averaged nearly $10,000 per home. Most of this cost was related to the older housing stock of participants that often required upgrading the entire electrical panel in a house. These costs can be a financial challenge for low-income households, limiting the scalability of a potentially effective solution for health and climate. Given the potential cost savings from reduced emergency room visits and hospitalizations, health payors may consider subsidizing the costs of changing gas stoves to electric stoves for patients with inadequately controlled asthma.

Author

• Ther Wint Aung, Case Western Reserve University
  Presenting Author