Does Ambient and Indoor Air Pollution Drive Hypertension in Young and Middle-Aged (30–49 years) Women in India? A Cross-Sectional Analysis

Air pollution, both ambient and indoor, is a significant contributor to cardiovascular oxidative stress, inflammation and elevated blood pressure, a key mechanism for hypertension. Hypertension has emerged as a significant public health concern in low- and middle-income countries (LMICs), including India. Previous studies have linked air pollution to hypertension in older adults, while the remaining young and middle-aged (YAMA) women (30–49 years) are also increasingly affected by hypertension due to prolonged exposure to environmental risks, particularly from cooking fuels and proximity to pollution sources. Therefore, this study investigates the association between ambient and household air pollution (HAP) with hypertension among YAMA women in India. We analysed data from the National Family Health Survey-five (NFHS-5) integrated with the PM_2.5 Grids database of NASA. Descriptive statistics and bivariate and multivariable statistical analyses were included. The results showed that the mean PM_2.5 level was 64.34 μg/m³, with a 21.91% prevalence of hypertension among women in India. The logistic regression model revealed that exposure to PM_2.5 and HAP increased the likelihood of hypertension by 1.036 times (p < 0.001) and 1.025 times (p < 0.001), respectively. Other risk factors, including women’s age, education, religion, caste, wealth index, self-smoking behaviour, body mass index, and diabetes, were also significantly associated with hypertension. These findings underscore the urgent need to address social and environmental determinants of hypertension burden among women. Public health policies should prioritize cleaner household energy sources and enforce stricter ambient air quality regulations in reducing the burden of hypertension and preventing cardiovascular diseases among women in India.