Exposure to household air pollution from biomass-burning cookstoves and HbA1c and diabetic status among Honduran women

Abstract

Household air pollution from biomass cookstoves is estimated to be responsible for more than two and a half million premature deaths annually, primarily in low and middle-income countries where cardiometabolic disorders, such as Type II Diabetes, are increasing. Growing evidence supports a link between ambient air pollution and diabetes, but evidence for household air pollution is limited. This cross-sectional study of 142 women (72 with traditional stoves and 70 with cleaner-burning Justa stoves) in rural Honduras evaluated the association of exposure to household air pollution (stove type, 24-hour average kitchen and personal fine particulate matter [PM_2.5 ] mass and black carbon) with glycated hemoglobin (HbA1c) levels and diabetic status based on HbA1c levels. The prevalence ratio (PR) per interquartile range increase in pollution concentration indicated higher prevalence of prediabetes/diabetes (vs normal HbA1c) for all pollutant measures (eg, PR per 84 μg/m³ increase in personal PM_2.5 , 1.49; 95% confidence interval [CI], 1.11-2.01). Results for HbA1c as a continuous variable were generally in the hypothesized direction. These results provide some evidence linking household air pollution with the prevalence of prediabetes/diabetes, and, if confirmed, suggest that the global public health impact of household air pollution may be broader than currently estimated.

Keywords: HbA1c; biomass cookstoves; cross-sectional study; developing countries; diabetes type II; indoor air pollution.

Figure 1

Examples of typical traditional cookstoves (left and middle) and a Justa (right) cookstove, in study communities near La Esperanza, Western Honduras

Figure 2. a-d: Distributions of 24-hour mean kitchen and personal PM_2.5 and black carbon concentrations for traditional and Justa stoves, Honduras

The lower boundary of the box (closest to zero) indicates the 25th percentile, the line within the box marks the median, and the upper boundary of the box (farthest from zero) indicates the 75th percentile. Bars indicate the 10th and 90th percentiles. Y-axes are on the log scale. PM_2.5: fine particulate matter