Effects of Household Air Pollution (HAP) on Cardiovascular Diseases in Low- and Middle-Income Countries (LMICs): A
Akorede Adekoya1, Sudhir K Tyagi2, Christiana N Duru3
1Global Health, McMaster University, Hamilton, ON L8S 4L8, Canada.
Insights
Household air pollution (HAP) significantly increases cardiovascular disease (CVD) risk and mortality, particularly in low- and middle-income countries (LMICs). This review synthesizes evidence on HAP
Area of Science:
- Environmental Health
- Cardiovascular Epidemiology
- Public Health
Background:
- Household air pollution (HAP) affects over 3 billion people globally, contributing to approximately 4 million premature deaths annually, primarily from cardiorespiratory diseases.
- While studies suggest HAP impacts cardiovascular health, existing findings are often inconsistent.
- Cardiovascular outcomes are a significant concern, especially in low- and middle-income countries (LMICs).
Purpose of the Study:
- To systematically review and critically appraise studies on the association between HAP and cardiovascular outcomes.
- To provide a pooled summary of findings, with a specific focus on LMICs.
- To clarify the relationship between HAP exposure and various cardiovascular conditions.
Main Methods:
- A systematic literature search was conducted across six databases, with the protocol registered on PROSPERO (CRD 42021248800).
- Included were peer-reviewed English-language studies published between 1980 and March 2021, focusing on adult populations (≥ 18 years).
- Study quality was assessed using the Newcastle-Ottawa Criteria, with heterogeneity and publication bias evaluated. A random-effects model was used for meta-analysis.
Main Results:
- Analysis of sixteen studies (547,463 cases) revealed that HAP exposure was associated with a 13% increased risk of cardiovascular diseases (CVDs) and a 21% higher risk of CVD mortality in LMICs.
- Statistically significant increased risks were observed for stroke, cerebrovascular accidents, heart failure, and hypertension.
- No significant associations were found for myocardial infarction, ischemic heart disease (IHD), eclampsia/preeclampsia, or carotid intima-media thickness.
Conclusions:
- Exposure to household air pollution (HAP) is linked to an elevated risk of cardiovascular outcomes.
- The findings highlight the substantial public health burden of HAP on cardiovascular health, particularly in LMICs.
- Further research and interventions are warranted to mitigate the cardiovascular risks associated with HAP exposure.
Background:
Out of over 3 billion people exposed to household air pollution (HAP), approximately 4 million die prematurely, most from cardiorespiratory diseases. Although many recent studies have reported adverse effects of HAP on cardiovascular outcomes, the findings are inconsistent.
Objectives:
The primary aim of this systematic review is to critically appraise the published studies and report the pooled summary of the findings on the association between HAP and cardiovascular outcomes, particularly in LMICs.
Methods:
During this systematic review and meta-analysis, six databases were searched systematically, and the protocol was published in PROSPERO (CRD 42021248800). Only peer-reviewed English-language studies published from 1980 to March 2021 were included. We extracted data for the population ≥ 18 years old. Newcastle-Ottawa Criteria were used to assess the quality of evidence. The heterogeneity and publication bias of the studies was evaluated. A meta-analysis was conducted using a random-effect model to pool the findings from published studies.
Results:
In sixteen studies totaling 547,463 cases, 319,180 were exposed to HAP. The pooled estimate suggested an overall 13% higher risk of CVDs, and a 21% higher risk of CVD mortality in LMICs among those exposed to HAP. Similarly, the increased risk of stroke and cerebrovascular accidents, heart failure, and hypertension was statistically significant among those exposed to HAP but not with myocardial infarction, IHD, eclampsia/preeclampsia, and carotid intima-media thickness.
Conclusions:
Our findings suggest exposure to HAP increases the risk of cardiovascular outcomes.
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