Prevalence of Cooking with Polluting Fuels and Association with Elevated Blood Pressure Among Adults in Port au Prince, Haiti: A Cross-Sectional Analysis.

Background: Cooking with polluting fuels is common in low- and middle-income countries and may impact blood pressure, yet data on this association in urban Haiti is limited. This study describes the prevalence of polluting fuel use and indoor cooking, evaluates their associations with blood pressure, and evaluates whether effects are heterogeneous by sex in urban Haiti.

Methods: Using cross-sectional data from the Haiti Cardiovascular Disease Cohort study, prevalence of polluting fuel use and indoor cooking was estimated. The associations between polluting fuel use and indoor cooking with systolic blood pressure (SBP), diastolic blood pressure (DBP) and hypertension (HTN) (mean SBP ≥140 mmHg or mean DBP ≥90 mmHg) were estimated using generalized estimating equations. The interaction between polluting fuel use and sex was also evaluated.

Results: Among 2,931 participants, 58.2% were female and the mean age was 42.0 (SD = 15.9) years. The majority (88.2%) primarily cooked with polluting fuels. Polluting vs clean fuel users tended to have less than a high school education (38.0% vs 22.8%), earn ≤ 1 USD/day (70.5% vs 67.4%), and have high food insecurity (85.0% vs 64.3%). Polluting vs clean fuel users had similar HTN prevalence (adjusted prevalence ratio [aPR] = 0.94, 95% CI: 0.80, 1.10). Average SBP was similar for women (0.99 mmHg, 95% CI: -1.46, 3.44) and lower for men (-4.80 mmHg, 95% CI: -8.24, -1.37) who used polluting vs clean fuels. Cooking indoors vs outdoors was associated with higher HTN prevalence (aPR = 1.12, 95% CI: 1.00, 1.25) and higher average SBP (1.67 mmHg, 95% CI: 0.15, 3.20).

Conclusions: This study demonstrates that most Haitians in Port-au-Prince cook with polluting fuels and often indoors. Those with higher poverty are more exposed, with mixed results in their association with blood pressure. Longitudinal studies are needed to clarify causal relationships and inform interventions promoting clean fuel use. (ClinicalTrials.gov Identifier: NCT03892265).