Global Health
Use of unclean cooking fuel and late-life cognitive outcomes among older women in India Adiba Hassan* Adiba Hassan Lara Cushing Jinkook Lee Emma Nichols Roch Nianogo Susan Cochran Elizabeth Rose Mayeda
Introduction: Women in resource-limited settings are disproportionately at risk of dementia due to early-life disparities and prolonged exposure to indoor air pollution from cooking in enclosed space. In this study, we add to prior findings of the effect of unclean cooking fuel (kerosene, charcoal, lignite, coal, dung cake) on cognitive performance using culturally appropriate and harmonized measures of cognitive performance among older Indian women, and assess any role of home type in modifying this effect.
Methods: We used cross-sectional data from 2,152 women aged ≥60 years surveyed in the nationally representative Harmonized Diagnostic Assessment of Dementia for the Longitudinal Aging Study in India (LASI-DAD). Generalized linear models estimated the effect of using unclean cooking fuel on risk of cognitive impairment (defined by low cognitive and Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) scores), and overall and domain-specific cognitive scores based on factor analysis structure of LASI-DAD cognitive battery, adjusted for potential confounders (Fig 1). As construction and material can influence home ventilation, filtration, and absorption capacity, we stratified on home type to evaluate effect measure modification.
Results: Compared with women using clean cooking fuel, women using unclean cooking fuel had 12% (95% CI 1.02, 1.23) higher risk of cognitive impairment, lower overall cognitive scores (-0.15, 95% CI -0.21, -0.09) and lower domain-specific cognitive scores. Home construction material modified this relationship: unclean cooking fuel was associated with 23% higher risk of cognitive impairment among women living in kutcha homes (grass, mud, polythene) (95% CI 1.06, 1.42), but not associated with cognitive impairment among women in pucca homes (cement, concrete, bricks), (RR=1.03, 95% CI 0.90, 1.18).
Conclusion: Upgrading kutcha homes and transitioning to clean fuel may reduce risk of cognitive impairment among Indian women.
