Association between Personal Exposure to Household Air Pollution and Glycated Hemoglobin among Women in Rural Areas of Guatemala, India, Peru, and Rwanda: Household Air Pollution Intervention Network Trial

Adolphe Ndikubwimana; Bonnie N Young; William Checkley; Yunyun Chen; Thomas Clasen; Carmen Lucía Contreras; Anaite A Diaz; Ephrem Dusabimana; Lisa de Las Fuentes; Sarada S Garg; Lindsay M Jaacks; Shirin Jabbarzadeh; Michael Johnson; Egide Kalisa; Patrick Karakwende; Miles Kirby; John P McCracken; Florien Ndagijimana; Theoneste Ntakirutimana; Dieu Ntivuguruzwa; Jennifer L Peel; Ricardo Piedrahita; Ajay Pillarisetti; Victor G Davila-Roman; Ghislaine Rosa; Kyle Steenland; Lindsay Underhill; Lance A Waller; Jiantong Wang; Wenlu Ye; Dana Boyd Barr; Naveen Puttaswamy; Maggie L Clark; HAPIN Investigators

doi:10.1289/JHP1053

Association between Personal Exposure to Household Air Pollution and Glycated Hemoglobin among Women in Rural Areas of Guatemala, India, Peru, and Rwanda: Household Air Pollution Intervention Network Trial

J Health Pollut. 2025 Jan 10;13(1-4):017002. doi: 10.1289/JHP1053. eCollection 2025 Dec.

Authors

Adolphe Ndikubwimana¹, Bonnie N Young², William Checkley³, Yunyun Chen⁴, Thomas Clasen⁵, Carmen Lucía Contreras⁶, Anaite A Diaz⁶, Ephrem Dusabimana⁷, Lisa de Las Fuentes⁸, Sarada S Garg⁹, Lindsay M Jaacks¹⁰, Shirin Jabbarzadeh⁴, Michael Johnson¹¹, Egide Kalisa¹², Patrick Karakwende¹, Miles Kirby¹⁰, John P McCracken⁶, Florien Ndagijimana⁷, Theoneste Ntakirutimana¹, Dieu Ntivuguruzwa⁷, Jennifer L Peel², Ricardo Piedrahita¹¹, Ajay Pillarisetti¹³, Victor G Davila-Roman⁸, Ghislaine Rosa¹⁴, Kyle Steenland⁵, Lindsay Underhill⁸, Lance A Waller⁴, Jiantong Wang⁴, Wenlu Ye¹³, Dana Boyd Barr⁵, Naveen Puttaswamy⁹, Maggie L Clark²; HAPIN Investigators

Affiliations

¹ School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda.
² Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, Colorado, USA.
³ Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.
⁴ Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.
⁵ Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.
⁶ Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala.
⁷ HAPIN Team Rwanda, Eagle Research Center, Kigali, Rwanda.
⁸ Caridiovascular Division, School of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA.
⁹ Department of Environmental Health Engineering, Indian Council of Medical Research (ICMR) Center for Advanced Research on Air Quality, Climate and Health, Sri Ramachandra Institute for Higher Education and Research (Deemed University), Chennai, India.
¹⁰ Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
¹¹ Berkeley Air Monitoring Group, Berkeley, California, USA.
¹² School of Sciences, Center of Excellence in Biodiversity and Natural Resource Management, College of Science and Technology, Kigali, Rwanda.
¹³ Environmental Health Sciences, School of Public Health, University of California, Berkeley, California, USA.
¹⁴ Department of Infectious and Tropical Diseases, Liverpool School of Tropical Medicine, Liverpool, UK.

Abstract

Background: Household air pollution from biomass cookstoves is a major concern in low- and middle-income countries because it may be linked with increasing rates of metabolic disorders such as diabetes. We assessed cross-sectional associations between household air pollution concentrations and glycated hemoglobin (HbA1c) levels.

Methods: We analyzed data from 346 women 40 to $< 80$ years of age who cooked with biomass fuel and were enrolled in the Household Air Pollution Intervention Network (HAPIN) Trial in Guatemala, India, Peru, and Rwanda. We explored associations of 24-h average personal exposure to fine particulate matter [PM $\leq 2.5 μ m$ in aerodynamic diameter ( ${PM}_{2.5}$ )], black carbon (BC), and carbon monoxide (CO) with HbA1c through individual pollutant linear models adjusted for potential confounders. We examined the effect modification of age, body mass index (BMI), and research site on the associations.

Results: We did not observe evidence of associations between HbA1c (percentage points) and 1-unit increases in log-transformed ${PM}_{2.5}$ [ $- 0.07$ ; 95% confidence interval (CI): $- 0.18$ , 0.05], BC (0.01; 95% CI: $- 0.15$ , 0.13), or CO (0.07; 95% CI: $- 0.24$ , 0.10). Effect modification of the BC associations with HbA1c was observed for BMI and research site. An association in the hypothesized direction was observed among women with high BMI ( $\geq 25 {kg / m}^{2}$ ): 0.13 (95% CI: $- 0.06$ , 0.31) compared with low BMI ( $< 25 {kg / m}^{2}$ ): $- 0.17$ (95% CI: $- 0.38$ , 0.04; $p_{interaction} = 0.04$ ). In the Guatemala research site, there was an association in the hypothesized direction with HbA1c and log-transformed BC (0.36; 95% CI: 0.03, 0.70) that was countered by an association in the opposite direction as that hypothesized for the India site ( $- 0.21$ ; 95% CI: $- 0.45$ , 0.02) and associations consistent with the null association in the Peru and Rwanda sites ( $p_{interaction} = 0.05$ ). No other evidence of effect modification was observed.

Conclusions: Evidence suggests a need for further research to better understand household air pollution's influence on HbA1c, with particular attention on potential effect modifiers. https://doi.org/10.1289/JHP1053.