title: Solid fuel use is a major risk factor for acute coronary syndromes among rural women: a matched case control study.
abstract: OBJECTIVE
  Almost half of the world's population uses solid fuel for cooking, exposing women to high levels of particulate pollution in indoor air. The risk of acute coronary syndrome (ACS) was assessed among rural women, according to their use of solid fuel.
  
  
  METHODS
  Matched case control study.
  
  
  METHODS
  Data were collected at a public tertiary care hospital in a rural district of Pakistan. Seventy-three women with ACS were compared with controls, individually matched for sex and age (± 5 years), who were admitted to hospital for other reasons. Fuels used for cooking and exposures to potentially confounding variables were ascertained through a questionnaire administered at interview and measurement of height and weight. Conditional logistic regression was used to estimate odds ratios (ORs) with 95% confidence intervals (95% CIs).
  
  
  RESULTS
  After adjustment for potential confounding factors, current use of solid fuel was strongly associated with ACS (OR 4.8, 95% CI: 1.5-14.8), and risk was lowest in women who had last used solid fuel more than 15 years earlier. The population attributable fraction for ACS in relation to current use of solid fuel was 49.0% (95% CI: 41.3%-57.4%).
  
  
  CONCLUSIONS
  These findings support the hypothesis that indoor air pollution from use of solid fuel is an important cause of ACS. Our study demonstrates the feasibility of case-control studies in rural populations of women to address this question, and is an encouragement to larger and statistically more powerful investigations.
authors.affiliation: Division of Environmental Health Sciences, Department of Community Health Sciences, Aga Khan University, Karachi, Sindh, Pakistan. Electronic address: zafar.fatmi@aku.edu.
authors.forename: Z
authors.initials: Z
authors.lastname: Fatmi
authors.affiliation: MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK.
authors.forename: D
authors.initials: D
authors.lastname: Coggon
authors.affiliation: Division of Environmental Health Sciences, Department of Community Health Sciences, Aga Khan University, Karachi, Sindh, Pakistan; Women Health Research Chair, King Saud University, Riyadh, Saudi Arabia.
authors.forename: A
authors.initials: A
authors.lastname: Kazi
authors.affiliation: Division of Environmental Health Sciences, Department of Community Health Sciences, Aga Khan University, Karachi, Sindh, Pakistan.
authors.forename: I
authors.initials: I
authors.lastname: Naeem
authors.affiliation: Division of Environmental Health Sciences, Department of Community Health Sciences, Aga Khan University, Karachi, Sindh, Pakistan.
authors.forename: M M
authors.initials: MM
authors.lastname: Kadir
authors.affiliation: Department of Epidemiology, University of Alabama at Birmingham, Birmingham, USA.
authors.forename: N
authors.initials: N
authors.lastname: Sathiakumar
mesh_terms: D054058:Acute Coronary Syndrome / Q000209:etiology*; D000328:Adult; D000368:Aged; D016902:Air Pollution, Indoor / Q000009:adverse effects*; D016022:Case-Control Studies; D003296:Cooking / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D005579:Fossil Fuels / Q000633:toxicity*; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D016017:Odds Ratio; D010154:Pakistan; D012307:Risk Factors; D012423:Rural Health / Q000706:statistics & numerical data*
chemical_list: D005579:Fossil Fuels
keywords: Acute coronary syndrome; Biomass fuel; Indoor air pollution; Matched case control; Risk factor; Women