Biomass Cooking Fuel Use and Screen-Detected Hypertension Among Peruvian Women Without Known Hypertension: A National Cross-Sectional Study

Household biomass combustion remains a source of household air pollution and unequal exposure among women. Its association with hypertension is biologically plausible, but evidence from Latin America remains limited, particularly when the analysis is restricted to women without a prior hypertension diagnosis, which represents the population of greatest interest for early screening. This study aimed to estimate the association between biomass cooking fuel use and screen-detected hypertension among Peruvian women aged 15–49 years without known hypertension. We conducted an analytical cross-sectional study using pooled DHS 2014–2024 microdata. Nonpregnant women aged 15–49 years with valid blood pressure measurements, cooking fuel information, complete covariates, and no self-reported diagnosis or current antihypertensive treatment were included. Screen-detected hypertension was defined as mean systolic blood pressure ≥ 140 mmHg or mean diastolic blood pressure ≥ 90 mmHg. Poisson regression with robust variance based on the complex sampling design was used to estimate prevalence ratios (PRs). The main model was adjusted for age, altitude, area of residence, natural region, education, wealth quintile, and survey year. Sensitivity, fuel-specific, effect-modification, positivity, sequential-adjustment, extended-adjustment, and continuous blood-pressure analyses were performed. The analytical sample included 301,575 women, of whom 78,499 used biomass/solid fuel and 18,571 had screen-detected hypertension. The weighted prevalence of screen-detected hypertension was 8.5% among clean-fuel users and 6.4% among biomass/solid-fuel users. The crude association was inverse (crude PR: 0.75; 95% CI: 0.71–0.79), but it reversed after adjustment (adjusted PR: 1.20; 95% CI: 1.10–1.31). Wood was associated with a higher adjusted prevalence (adjusted PR: 1.25; 95% CI: 1.14–1.36). Coal/charcoal showed an imprecise null estimate (adjusted PR: 1.00; 95% CI: 0.76–1.31). The association was stronger in urban than in rural areas (adjusted PR: 1.28 vs. 1.09; interaction p = 0.005). Among Peruvian women without known hypertension, biomass/solid cooking fuel use was associated with a higher adjusted prevalence of screen-detected hypertension, supporting the inclusion of clean-fuel transition within integrated cardiovascular prevention strategies.