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 TOBACCO CONTROL ISSUE - ORIGINAL ARTICLE
Year : 2014  |  Volume : 51  |  Issue : 5  |  Page : 73-77

Smokeless tobacco use: A meta-analysis of risk and attributable mortality estimates for India


1 World Health Organization, Regional Office for South-East Asia, New Delhi, India
2 Centers for Disease Control and Prevention, Atlanta, Georgia, USA
3 Healis Sekhsaria Institute for Public Health, Navi Mumbai, Maharashtra, India
4 Michael's Hospital and University of Toronto, Toronto, Canada
5 Ex department of Biostatistics and Medical Informatics, Delhi University College of Medical Sciences, New Delhi, India
6 Epidemiological Research Centre, Chennai, Tamil Nadu, India

Correspondence Address:
D N Sinha
World Health Organization, Regional Office for South-East Asia, New Delhi, India

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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-509X.147477

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Background: Use of smokeless tobacco (SLT) is widely prevalent in India and Indian subcontinent. Cohort and case-control studies in India and elsewhere report excess mortality due to its use. Objective: The aim was to estimate the SLT use-attributable deaths in males and females, aged 35 years and older, in India. Materials And Methods: Prevalence of SLT use in persons aged 35 years and older was obtained from the Global Adult Tobacco Survey in India and population size and deaths in the relevant age-sex groups were obtained from UN estimates (2010 revision) for 2008. A meta-relative risk (RR) based population attributable fraction was used to estimate attributable deaths in persons aged 35 years and older. A random effects model was used in the meta-analysis on all-cause mortality from SLT use in India including four cohort and one case-control study. The studies included in the meta-analysis were adjusted for smoking, age and education. Results: The prevalence of SLT use in India was 25.2% for men and 24.5% for women aged 35 years and older. RRs for females and males were 1.34 (1.27-1.42) and 1.17 (1.05-1.42), respectively. The number of deaths attributable to SLT use in India is estimated to be 368127 (217,076 women and 151,051 men), with nearly three-fifth (60%) of these deaths occurring among women. Con Clusion: SLT use caused over 350,000 deaths in India in 2010, and nearly three-fifth of SLT use-attributable deaths were among women in India. This calls for targeted public health intervention focusing on SLT products especially among women.






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