Solid fuel use is a major risk factor for acute coronary syndromes among rural women: a matched case control study

Abstract

Objectives Almost half of the world’s population uses solid fuel for cooking, exposing women to high levels of particulate pollution in indoor air. We assessed the risk of acute coronary syndrome (ACS) among rural women, according to their use of solid fuel. Study design Matched case control study. Methods Data were collected at a public tertiary care hospital in a rural district of Pakistan. Seventy-three women with ACS were compared with controls, individually matched for sex and age (±5years), who were admitted to hospital for other reasons. Fuels used for cooking and exposures to potentially confounding variables were ascertained through a questionnaire administered at interview and measurement of height and weight. Conditional logistic regression was used to estimate odds ratios (ORs) with 95% confidence intervals (95% CIs). Results After adjustment for potential confounding factors, current use of solid fuel was strongly associated with ACS ( OR 4.8, 95% CI: 1.5 to 14.8), and risk was lowest in women who had last used solid fuel more than 15 years earlier. The population attributable fraction for ACS in relation to current use of solid fuel was 49.0% (95% CI: 41.3% - 57.4%). Conclusions These findings support the hypothesis that indoor air pollution from use of solid fuel is an important cause of ACS. Our study demonstrates the feasibility of case-control studies in rural populations of women to address this question, and is an encouragement to larger and statistically more powerful investigations.

Household Fuel Use and Cardiovascular Disease Mortality

“…1,2 While these deaths are traditionally attributed to pneumonia in children and chronic obstructive pulmonary disease and lung cancer in adults, 3 data attempting to show a direct link between HAP and cardiovascular disease (CVD) mortality are limited. 4 Inferences regarding the relationship between HAP and CVD are largely based on a growing body of evidence showing that HAP is associated with CVD risk factors and morbidity, 5-13 as well as known data associating ambient air pollution and direct tobacco inhalation with CVD mortality. 14-16 …”

Biomass Cooking Fuels and Health Outcomes for Women in Malawi

“…HAP is associated with numerous cardiopulmonary health problems, including chronic obstructive pulmonary disease (COPD) (Hu et al 2010; Kurmi et al 2010; Po et al 2011; McCracken et al 2012; Finney et al 2013), acute coronary syndrome (Fatmi et al 2014), cardiovascular disease (Brook et al 2010; McCracken et al 2012; Noubiap et al 2015; Sinha and Ray 2015), and blood pressure (Baumgartner et al 2011, 2014; Peña et al 2015). HAP emissions are also associated with cancers (lung, mouth, pharynx etc.)…”

Targeting Household Air Pollution for Curbing the Cardiovascular Disease Burden: A Health Priority in Sub‐Saharan Africa

“…The population-attributable fraction for acute coronary syndrome in relation to current use of solid fuel was 49.0% (95% CI, 41.3%-57.4%). 9 Moreover, a retrospective cohort study in Bangladesh assessed adult cardiopulmonary mortality over a 10-year period in relation to household fuel type as a surrogate for exposure to indoor air pollution. 10 Cause-specific mortality data were obtained through verbal autopsy as part of a permanent surveillance.…”

“…1,14 Still, household use of solid fuels and secondhand smoke (reflecting one's smoking habits at home 13 ) are both markers of indoor air pollution. 9 Moreover, ambient outdoor air pollution, secondhand smoke, and HAP share several common aspects. Indeed, each of the pollutant mixtures contains PM and toxic gases.…”