The association of cooking fuels with depression and anxiety symptoms among adults aged ≥65 years from low- and middle-income countries

Background: We aimed to investigate associations of unclean cooking fuels with depression and anxiety symptoms in a large sample of adults aged ≥65 years from six low- and middle-income countries (LMICs). Methods: Cross-sectional, community-based, nationally representative data from the WHO Study on global AGEing and adult health (SAGE) were analyzed. Unclean cooking fuel referred to kerosene/paraffin, coal/charcoal, wood, agriculture/crop, animal dung, and shrubs/grass. Depression referred to DSM-IV depression based on past 12-month symptoms or receiving depression treatment in the last 12 months. Anxiety symptoms referred to severe/extreme problems with worry or anxiety in the past 30 days. Multivariable logistic regression analysis and meta-analysis were conducted. Results: Data on 14,585 people aged ≥65 years were analyzed [mean (SD) age 72.6 (11.5) years; maximum age 114 years; 55.0% females]. After adjustment for potential confounders, unclean cooking fuel was associated with a significant 2.52 (95%CI = 1.66-3.82) times higher odds for depression with a low level of between-country heterogeneity (I2 = 0.0%). For anxiety symptoms, unclean fuel use was not significantly associated with anxiety symptoms (OR = 1.13; 95%CI = 0.77-1.68; I2 = 0.0%). Limitations: 1. Cross-sectional design. 2. Self-reported measures. 3. No information about outdoor pollution exposure, personal exposure, and smoke composition of different cooking fuels. Conclusions: Unclean cooking fuel was significantly associated with higher odds for depression, but not anxiety, with little observed variability between settings. Findings from the present study provide further support and call for action in appropriate implementation of the United Nations Sustainable Goal 7, which advocates affordable, reliable, sustainable, and modern energy for all.