A Prospective Study of Tobacco Smoking and Mortality in Bangladesh |
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Authors: | Fen Wu Yu Chen Faruque Parvez Stephanie Segers Maria Argos Tariqul Islam Alauddin Ahmed Muhammad Rakibuz-Zaman Rabiul Hasan Golam Sarwar Habibul Ahsan |
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Institution: | 1. Department of Population Health, New York University School of Medicine, New York, New York, United States of America.; 2. Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York City, New York, United States of America.; 3. Department of Health Studies, The University of Chicago, Chicago, Illinois, United States of America.; 4. U-Chicago Research Bangladesh, Ltd., Dhaka, Bangladesh.; The Ohio State University, United States of America, |
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Abstract: | BackgroundLimited data are available on smoking-related mortality in low-income countries, where both chronic disease burden and prevalence of smoking are increasing.MethodsUsing data on 20, 033 individuals in the Health Effects of Arsenic Longitudinal Study (HEALS) in Bangladesh, we prospectively evaluated the association between tobacco smoking and all-cause, cancer, and cardiovascular disease mortality during ∼7.6 years of follow-up.Cox proportional hazards models were used to estimate hazard ratios (HRs) and their 95% confidence intervals (CIs) for deaths from all-cause, cancer, CVD, ischemic heart disease (IHD), and stroke, in relation to status, duration, and intensity of cigarette/bidi and hookah smoking.ResultsAmong men, cigarette/bidi smoking was positively associated with all-cause (HR 1.40, 95% CI 1.06 1.86) and cancer mortality (HR 2.91, 1.24 6.80), and there was a dose-response relationship between increasing intensity of cigarette/bidi consumption and increasing mortality. An elevated risk of death from ischemic heart disease (HR 1.87, 1.08 3.24) was associated with current cigarette/bidi smoking. Among women, the corresponding HRs were 1.65 (95% CI 1.16 2.36) for all-cause mortality and 2.69 (95% CI 1.20 6.01) for ischemic heart disease mortality. Similar associations were observed for hookah smoking. There was a trend towards reduced risk for the mortality outcomes with older age at onset of cigarette/bidi smoking and increasing years since quitting cigarette/bibi smoking among men. We estimated that cigarette/bidi smoking accounted for about 25.0% of deaths in men and 7.6% in women.ConclusionsTobacco smoking was responsible for substantial proportion of premature deaths in the Bangladeshi population, especially among men. Stringent measures of tobacco control and cessation are needed to reduce tobacco-related deaths in Bangladesh. |
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