Solid fuel use status in the household and the risk of elevated blood pressure: findings from the 2017/18 Bangladesh Demographic and Health Survey

Introduction Prevalence of hypertension is now increasing rapidly in Bangladesh, particularly among the socio-economically disadvantaged population. This could be linked to their higher use of solid fuel; however, related evidence is scarce in Bangladesh. We aimed to determine the associations of household solid fuel use and its exposure level with systolic blood pressure, diastolic blood pressure and hypertension. Methods Total of 7,320 women’s data extracted from the 2017/18 Bangladesh Demographic and Health Survey were analysed. We considered three outcome variables: (i) systolic blood pressure (continuous response), (ii) diastolic blood pressure (continuous response) and (iii) hypertension status (yes, no). Cooking fuel use ( clean fuel vs solid fuel ) and levels of exposure to household air pollution (HAP) through solid fuel use (unexposed, moderately exposed, highly exposed) were our primary exposure of interest. A multilevel mixed-effects Poisson regression model with robust variance was used to determine the association between exposure and outcome variable adjusting for confounders. Results Around 82% of the total respondents analysed used solid fuel for cooking. The overall age-standardised prevalence of hypertension was 28%. The likelihood of becoming hypertension was found 1.44 times (95% CI, 1.04-1.89) higher among respondents who used solid fuel as compared to the respondents who used clean fuel. The likelihood of hypertension was found to be increased with the increased exposure to HAP through the solid fuel used; 1.61 times (95% CI, 1.07-2.20) higher among the moderate exposure group and 1.80 times (95% CI, 1.27-2.32) higher among higher exposure group as compared to the women who used clean fuel. Similar associations were reported for systolic blood pressure and diastolic blood pressure. Conclusion Solid fuel use elevate systolic blood pressure, diastolic blood pressure and increases the likelihood of becoming hypertensive. Policies and programs are important to increase awareness about the adverse effects of solid fuel use on health, including hypertension. Focus should also be given to reducing solid fuel use and ensuring proper ventilation at the solid fuel use place. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement The authors did not receive any funds for this study. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes The Demography and Health Survey (DHS) program of the USA is the custodian of 2017 BDHS data. It is freely available for the user upon submission of reasonable requests to the DHS.