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Public Health. 2014 Jan;128(1):77-82. doi: 10.1016/j.puhe.2013.09.005. Epub 2013 Dec 14.

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

Author information

  • 1Division of Environmental Health Sciences, Department of Community Health Sciences, Aga Khan University, Karachi, Sindh, Pakistan. Electronic address: zafar.fatmi@aku.edu.
  • 2MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK.
  • 3Division of Environmental Health Sciences, Department of Community Health Sciences, Aga Khan University, Karachi, Sindh, Pakistan; Women Health Research Chair, King Saud University, Riyadh, Saudi Arabia.
  • 4Division of Environmental Health Sciences, Department of Community Health Sciences, Aga Khan University, Karachi, Sindh, Pakistan.
  • 5Department of Epidemiology, University of Alabama at Birmingham, Birmingham, USA.

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. The risk of acute coronary syndrome (ACS) was assessed 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 (± 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.

Copyright © 2013 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

KEYWORDS:

Acute coronary syndrome; Biomass fuel; Indoor air pollution; Matched case control; Risk factor; Women

PMID:
24342134
[PubMed - indexed for MEDLINE]
PMCID:
PMC3964605
Free PMC Article
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