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

Abstract

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 (±5 years), 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: 1.5–14.8), 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.

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Identifiers

ORCID for D. Coggon: orcid.org/0000-0003-1930-3987

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