Evaluating associations between the transition to cleaner cooking energy use and hypertension in India

Abstract Sustainable Development Goal 7 aims to ensure access to clean and affordable energy for all. India has implemented large-scale policies to improve access to clean fuels (CFs) such as liquefied petroleum gas. However, the impacts of such policies on public health outcomes have been understudied. This study utilized data from India’s National Family Health Surveys (NFHSs) conducted in 2016 and 2021 to evaluate the associations between changes in the prevalence of non-CF (non-CF) usage, driven by India’s clean energy policies, and hypertension, a significant cardiovascular disease risk factor, on a national level. Specifically, a precision-weighted method that accounts for survey design and sampling variability was implemented to estimate the prevalence of hypertension and a wide range of socio-economic (SES) factors for the years 2010–2015 (NFHS-4) and 2015–2020 (NFHS-5) at the district level for the 2019/20 NFHS-5. Associations between the change in solid-fuel use, also termed as non-CF at the district level between 2015–2020 and 2010–2015, and the change in the prevalence of hypertension after controlling for various SES were investigated using regression analyzes. A significant decrease in hypertension prevalence: 0.41% (95% CI: 0.07%, 0.75%) was associated with a 10% point decrease in the prevalence of non-CF use at the district level. Subpopulation-specific analyzes revealed substantial variation in associations by gender, region, urban/rural designation, socioeconomic groups, and age. Specifically, these associations were highest among older populations and residents of North India.