Household air pollution and association with heart disease among women in India: evidence from the nationally representative survey (NFHS-5).

BACKGROUND: Based on an increased prevalence of chronic respiratory conditions among women of reproductive age, understanding the risk factors of heart disease is crucial to inform policy and program interventions to address the problem. In this study, we empirically assessed the associations of behavioural factors such as the use of cooking fuels, smoking behaviour, household air pollution (HAP), and various demographic and socioeconomic characteristics with the prevalence of heart diseases in women. METHODS: The data were derived from the National Family Health Survey (NFHS) conducted in 2019-2021. The effective sample size for the present study was 7,24,115 women aged 15-49 years in India. Descriptive statistics, along with bivariate analysis were conducted to find the preliminary results. Further, multivariable binary logistic regressions were conducted to find the relationship between heart disease and behavioural factors such as cooking fuel, smoking behaviour and HAP. RESULTS: It was revealed that women aged more than 29 years are at higher risk for heart disease (p < 0.05), irrespective of using clean cooking fuel (CCF) or polluting cooking fuel (PCF). Besides, women who are overweight (PCF = 1.15%; p < 0.05), have diabetes (PCF = 5.33%; p < 0.05), and have hypertension (PCF = 1.44%; p < 0.05) tend to have higher prevalence of risk of heart disease as they were using PCF. Furthermore, the odds ratio of heart disease was higher among women having exposure to smoking (OR:1.227; CI:1.130-1.333; p < 0.05), aged 45-49 (OR:2.474; CI:2.258-2.710; p < 0.05), lower education (OR:1.144; CI:1.048-1.249; p < 0.05), poorer wealth status (OR: 1.103; CI:1.011-1.203; p < 0.05), diabetes (OR: 4.677; CI: 4.297-5.09; p < 0.05), hypertension (OR: 1.48; CI: 1.386-1.58; p < 0.05) and current smoker (OR: 1.428; CI:1.304-1.565; p < 0.05). CONCLUSION: The findings revealed that uses of PCF lead to HAP and is a contributing component to heart diseases. To address these challenges, the study suggests promoting alternative and CCF and raising awareness about the health hazards associated with HAP. Policy interventions focused on expanding access to clean fuels, and knowledge are crucial to achieving sustainable development goals and mitigating the impact of heart disease. Organizations dedicated to public health and environmental well-being should enhance efforts to promote the adoption of clean cooking alternatives, thereby reducing the burden of heart disease among women in India.