Background Most households in developing countries like India are not able to afford to get the services of efficient energy for cooking and lighting. Therefore, they rely mostly on solid fuels (firewood, dung cakes, crop residue, coal/coke/lignite). Such fuels cause respiratory diseases like tuberculosis, asthma respiratory cancer. Hence, this study aims to estimate the association between different types of energy used and the prevalence of respiratory diseases in India where more than 50% of the population relies on solid fuels for cooking. Methods The study is based on 117,752 respondents who were diagnosed with various chronic diseases such as diabetes, chronic heart diseases, leprosy, chronic renal diseases, tuberculosis, asthma etc. from District Level Household Survey (DLHS-4) which was conducted in 2012–13. Individuals who were diagnosed with a chronic illness after a proper medical examination have been considered as a dependent variable. Exposure to the type of cooking fuel is the main exposure variable, which recognises the dependence on energy. Logistic regression has been utilized to understand the association between the use of solid fuels for cooking and the prevalence of respiratory diseases. Results The dependence on solid fuels is very high in rural areas (72.22%) as compared to urban areas (21.43%). Among different castes, the reliance on solid fuels for cooking is highest among Scheduled Castes (61.79%) and Scheduled Tribes (70.46%). Individuals living in households where crop residue and coal/lignite is used for cooking suffer from asthma/chronic respiratory failure in the higher proportion as compared to others. Results further revealed that the use of solid fuels for cooking has a strong association with respiratory diseases. Individuals living in households where solid fuels like firewood [OR: 1.27 (0.001); C.I.: 1.19–1.35], crop residue [OR: 1.33 (0.001); C.I.:1.19–1.48], and coal [OR: 1.60 (0.001); C.I.:1.32–1.93] are used as primary fuel for cooking are 17 to 60% more likely to suffer from respiratory diseases. Conclusion Use of solid fuels is associated with respiratory diseases like asthma, tuberculosis and cancer of the respiratory system. Assuming these associations are causal, therefore, about 17 to 60% of the respiratory diseases in India could be prevented by providing access to clean cooking fuel to the individuals.

Background. The use of solid fuels in household cooking contributes to indoor air pollution and is the cause of more than 4 million deaths around the world annually. Solid fuel use varies with the level of development and ranges from 0% in high-income countries to more than 80% in low- and middle-income countries. Three billion people (more than 40% of the global population) are still dependent on solid fuels like firewood, dung cakes, coal, wood and agricultural residues in these countries. Objectives. The present study aims to analyze the association of certain respiratory diseases (tuberculosis (TB), acute upper respiratory infections (AURI), chronic obstructive pulmonary diseases (COPD), and bronchial asthma) with the use of solid fuels for cooking across sociodemographic groups in India. Methods. The 71st round of the National Sample Survey, conducted in 2014, was used. In total, 54,985 inpatients who received medical treatment from any medical institution during the last 365 days preceding the survey and who reported various diseases, such as infections, cancers, blood diseases, cardiovascular diseases, and respiratory diseases were included in the analysis. Of these inpatients, 2513 participants who reported TB, AURI, COPD and bronchial asthma were considered the dependent variables in the study. The main variable was exposure to different types of fuels used as a primary source of energy for cooking. Multinomial logistic regression was used to explain associations. Results. The results reveal a significant association between solid fuel use and respiratory diseases in India. Overall, more than 60% of the population uses firewood and cow dung as their primary source of energy for cooking and are at a higher risk of TB, COPD and bronchial asthma. In rural areas there is a high dependence on solid fuels (80.5%) and a higher risk of respiratory diseases compared to those residing in urban areas where people are less dependent on solid fuels (22%). Among different socio-demographic groups, the dependence on solid fuels is highest among Scheduled Tribes (87.42%), followed by Scheduled Castes (74.78%) and Other Backward Classes (OBCs) (a term used by the Indian government to categorize castes that face social or educational challenges) (64.47%). Scheduled Tribes have the highest risk of TB, followed by Scheduled Castes and OBCs, respectively. Conclusions. Exposure to solid fuels for cooking increases the potential risk of TB, COPD and bronchial asthma. Access to clean and efficient fuels for cooking is essential to reduce the burden of respiratory disease. Measures are needed to increase the availability of clean fuels for households, especially among socially disadvantaged and marginalized groups, to reduce the burden of respiratory diseases in India. Competing Interests. The authors declare no competing financial interests

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