Stroke is a major contributor to the global burden of diseaseGlobal burden of disease, particularly in low- and middle-income countries, where air pollution is an emerging risk factor. This study explored the impact of indoor cooking fuel use on blood pressure and stroke among elderly individuals in the Bankura district of West Bengal. The present study was conducted among 332 participants aged 45 years and above. The analysis revealed a higher prevalence of stroke in households using solid fuel for cooking (17.2%) compared to those using clean fuel (12.5%). Individuals with systolic blood pressure (SBP) ≥ 140 mmHg or diastolic blood pressure (DBP) ≥ 90 mmHg had an increased stroke risk. Females experienced a higher prevalence of stroke than males (20.1 vs. 18.8%). Obese and underweight participants were at greater risk than those with a normal weight. Key risk factors for stroke included age 65–74 years (OR = 3.69, p = 0.004), high body mass index (OR = 3.05, p = 0.005), alcohol consumption (OR = 2.24, p = 0.004), and smoking (OR = 1.96, p < 0.001). The findings highlight high blood pressure as an independent risk factor for stroke, emphasizing the need for targeted awareness and intervention strategies among middle-aged and elderly populations to mitigate stroke prevalence and its associated complications.