Association of cooking fuel type with hypertension risk: a systematic review and meta-analysis

TL;DR

Using solid cooking fuels increases the risk of hypertension compared to clean fuels, according to a systematic review and meta-analysis.

Contribution

This study provides the first comprehensive meta-analysis linking solid cooking fuel use to elevated hypertension risk.

Findings

Solid cooking fuels were associated with a 13% higher odds of hypertension compared to clean fuels.

Solid fuel use was linked to a small but significant increase in systolic blood pressure.

No significant association was found between solid fuel use and diastolic blood pressure.

Abstract

Hypertension is a major global health concern and a leading cause of mortality, contributing to functional and structural damage in vital organs. Emerging evidence suggests that household air pollution (HAP) from the combustion of cooking fuels, plays a critical role in influencing the prevalence and mortality rates of hypertension. This systematic review and meta-analysis aims to investigate the association between different cooking fuel types and hypertension risk.

The study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was registered with PROSPERO (CRD42024589847). A comprehensive literature search was performed across multiple databases, including PubMed, Embase, Cochrane, WOS, CNKI, VIP, Wanfang, and SinoMed up to September 3, 2024. Study quality was assessed using the Newcastle-Ottawa Scale (NOS) and the National Institutes of Health (NIH) Quality Assessment Tool. Statistical analyses were conducted using Stata 15.1 software. Heterogeneity was assessed using the Q-test and I² statistic, and an appropriate random-effects model (REM) or fixed-effects model (FEM) was applied based on the degree of heterogeneity observed.

The analysis revealed that the use of solid cooking fuels was significantly associated with increased odds of hypertension compared to clean cooking fuels (OR = 1.13, 95% CI: 1.03–1.25). Solid cooking fuel use was associated with higher systolic blood pressure (SMD = 0.12, 95% CI: 0.01–0.24), although the difference may be close to the critical level. However, the association with diastolic blood pressure was not significant (SMD = 0.05, 95% CI: -0.06–0.16). Neither subgroup analysis nor meta-regression identified sources of heterogeneity, while sensitivity analyses and subgroup analysis confirmed robust results.Sensitivity analyses confirmed the stability of the results, with no evidence of significant publication bias.

This study provides evidence that solid cooking fuel use is associated with an elevated risk of hypertension. Despite limitations such as heterogeneity across study designs, the findings provide a strong scientific basis for policy interventions promoting a transition to cleaner cooking fuels. Future research should prioritize longitudinal or prospective study designs to enhance the quality of evidence and further elucidate this relationship.

The online version contains supplementary material available at 10.1186/s12889-025-26168-5.

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