Exposure-response Relationship Between Personal Exposure to Household Air Pollution and Blood Pressure in Adult Women Across Four Resource-Poor Settings

Introduction: Household air pollution (HAP), resulting from the burning of solid fuels, may be an important cause of elevated BP in low- and middle-income countries. Here we sought to evaluate the association between BP and personal PM2.5 exposure, using baseline data from the Household Air Pollution Intervention Network trial in 418 non-pregnant, non-smoking women aged 40–79 years using biomass cookstoves across four resource-poor settings in India, Guatemala, Peru and Rwanda. Methods: Systolic (SBP) and diastolic blood pressure (DBP) were obtained within a day of 24-hour personal PM2.5 measurements collected with a gravimetric sampler. We collected socioeconomic and demographic information through questionnaires and used principal component analysis to construct a socioeconomic status (SES) index. We used generalized additive models to characterize the association between BP and personal PM2.5 exposures, taking into account the interaction between PM2.5 exposure and age and adjusting for site and SES index. Results: A total of 418 women (mean age 52.2±7.9 years) were included in this analysis. The interquartile range of PM2.5 exposures was 42.9–139.5 μg/m3. SBP was positively associated with PM2.5 exposure in women above 64 years of age. On average, SBP of women aged 65 years was 10.8 mmHg (95% CI 1.0–20.6) higher at 232 μg/m3 of PM2.5 exposure (90th percentile) when compared to that of women with personal exposures of 10 μg/m3. We found no significant differences in DBP with PM2.5 exposure at any age. Conclusion: Our findings suggest that reducing HAP exposures may help to reduce BP, particularly among older women.