Association between charcoal cooking fuel and cardiovascular disease prevalence in Haiti: a cross-sectional analysis

There is little evidence on the association between cooking with polluting fuels, particularly charcoal, and heart disease from low- and middle-income countries, which have the highest burdens of polluting fuels and cardiovascular disease (CVD). We sought to assess the relationship between self-reported primary home cooking with charcoal and prevalent cardiovascular disease in the low-income country Haiti. Demographic and clinical data were collected from 3,005 adults in the Haiti Cardiovascular Disease Cohort, recruited from Port-au-Prince using multistage random sampling from 2019 to 2021. Primary cooking fuel was self-reported in the household: charcoal orliquified petroleum gas (LPG). Prevalent CVD (heart failure, stroke, myocardial infarction) was physician-adjudicated using epidemiological criteria similar to international cohorts. Multivariable generalized estimating equations with a Poisson distribution estimated prevalence ratios of prevalent CVD by polluting charcoal vs. LPG. Among 2,865 adults in the analytic sample, median age was 41 years (IQR 28–55), 57.9% female, and 88.4% reported using charcoal cooking fuel. Age-adjusted prevalence of any CVD was 13.7% (95% CI 12.2%, 15.4%) with the most common subtype being heart failure. Cooking with charcoal versus LPG was associated with higher prevalence of heart failure (1.63 prevalence ratio; 95% confidence interval 1.09, 2.44) after multivariable adjustment, lower prevalence of stroke, and not significantly associated with myocardial infarction or any CVD. Most urban Haitian adults cook with charcoal, an uncommon primary cooking fuel in other countries, and charcoal is associated with higher prevalence of heart failure compared to LPG. Polluting charcoal cooking fuel is a potentially modifiable risk factor for heart failure in low-income settings that needs remediation and intervention. Registry: clinicaltrials.gov.