Mass-size distribution of respirable aerosol and 13 associated trace elements (TEs) were investigated in rural kitchens using liquefied petroleum gas (LPG), firewood and mixed biomass fuels across three northeastern Indian states. The averaged PM10 (particulate matter with aerodynamic diameter ≤ 10 μm) and ΣTE concentrations were 403 and 30 μg m−3 for LPG, 2429 and 55 μg m−3 for firewood, and 1024 and 44 μg m−3 for mixed biomass-using kitchens. Mass-size distributions were tri-modal with peaks in the ultrafine (0.05–0.08 μm), accumulation (0.20–1.05 μm), and coarse (3.20–4.57 μm) modes. Respiratory deposition, estimated using the multiple path particle dosimetry model, ranged from 21 % to 58 % of the total concentration across fuel types and population age categories. Head, followed by pulmonary and tracheobronchial, was the most vulnerable deposition region, and children were the most susceptible age group. Inhalation risk assessment of TEs revealed significant non-carcinogenic as well as carcinogenic risk, especially for biomass fuel users. The potential years of life lost (PYLL) was the highest for chronic obstructive pulmonary disease (COPD: 15.9 ± 3.8 years) followed by lung cancer (10.3 ± 0.3 years) and pneumonia (10.1 ± 0.1 years), while the PYLL rate was also highest for COPD, with Cr(VI) being the major contributor. Overall, these findings reveal the significant health burden faced by the northeastern Indian population from indoor cooking using solid biomass fuels.