Effect of cleaner cooking fuel (LPG) on cardiopulmonary health in women from rural Maharashtra

Introduction: One-third of the world's population relies on solid fuels for cooking, contributing significantly to Household Air Pollution (HAP). In 2020, HAP exposure resulted in 3.2 million global deaths, primarily impacting women. India's government has taken steps to address this issue through the Pradhan Mantri Ujjwala Yojana (PMUY), providing Liquefied Petroleum Gas (LPG) connections to those below the poverty line. Despite recognized environmental benefits, there is a lack of studies exploring the comprehensive intervention's impact on cardiopulmonary health benefits. Methods: A total of 808 healthy non-smoker women participants, either continuing to cook with traditional fuel or adopting LPG under PMUY, were included. Blood pressure was measured in all study participants. Lung function (measured by spirometry) and 24-hour kitchen PM2.5 concentration data were collected in a subset (n=309) using a standardized protocol and calibrated instruments. Results: In the LPG group, both systolic and diastolic blood pressure were significantly lower compared to the biomass group (119.5 vs. 125.3 mmHg, 76.0 vs. 79.0 mmHg; p<0.001), with a lower prevalence of hypertension (21.1% vs. 29.5%; <0.001). Adjusted models showed a significantly lower hypertension risk among LPG users [OR 95% CI: 0.61 (0.43–0.86); p=0.004]. The LPG group exhibited improved spirometry indices [FEV1 (2.26 vs. 2.05 L) and FVC (2.78 vs. 2.46 L); p<0.001] and a reduced prevalence of small airway obstruction (SAO) (15.1% vs. 35.7%; p<0.001) and obstructive airway disease (OAD) (1.3% vs. 7.6%; p ≤ 0.05) compared to the biomass group. Although not statistically significant, the LPG group showed an approximately 43% lower risk of developing SAO and OAD. Additionally, LPG kitchens demonstrated 13.2 times lower PM2.5 concentrations than biomass kitchens. Conclusion: The use of solid fuels is associated with an increased prevalence of hypertension, SAO, and OAD. In contrast, the use of cleaner cooking fuels like LPG is associated with better health outcomes.