Case–control study of indoor cooking smoke exposure and cataract in Nepal and India

BACKGROUND: The prevalence of cataract is higher in developing countries, and in both developed and developing countries more females than males are blind from cataracts. Three epidemiological studies have associated indoor cooking with solid fuels (e.g. wood or dung) and cataract or blindness. However, associations in these studies may have been caused by unmeasured confounding. METHODS: A hospital-based case-control study was conducted on the Nepal-India border. Cases (n = 206) were women patients, aged 35-75 years with confirmed cataracts. Controls (n = 203), frequency matched by age, were patients attending the refractive error clinic at the same hospital. A standardized questionnaire was administered to all participants. Logistic regression analysis involved adjustment for age, literacy, residential area, ventilation, type of lighting, incense use, and working outside. RESULTS: Compared with using a clean-burning-fuel stove (biogas, LPG, or kerosene), the adjusted odds ratio (OR) for using a flued solid-fuel stove was 1.23 95% confidence interval (CI) 0.44-3.42, whereas use of an unflued solid-fuel stove had an OR of 1.90 (95% CI 1.00-3.61). Lack of kitchen ventilation was an independent risk factor for cataract (OR 1.96; 95% CI 1.25-3.07). CONCLUSION: This study provides confirmatory evidence that use of solid fuel in unflued indoor stoves is associated with increased risk of cataract in women who do the cooking. The association is not likely to be due to bias, including confounding, and strengthens the findings of three previous studies. Replacing unflued stoves with flued stoves would greatly reduce this risk, although cooking with cleaner-burning fuels would be the best option.