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Published at www.nejm.org February 13, 2008 (10.1056/NEJMsa0707719)

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ABSTRACT

Background The nationwide effects of smoking on mortality in India have not been assessed reliably.

Methods In a nationally representative sample of 1.1 million homes, we compared the prevalence of smoking among 33,000 deceased women and 41,000 deceased men (case subjects) with the prevalence of smoking among 35,000 living women and 43,000 living men (unmatched control subjects). Mortality risk ratios comparing smokers with nonsmokers were adjusted for age, educational level, and use of alcohol.

Results About 5% of female control subjects and 37% of male control subjects between the ages of 30 and 69 years were smokers. In this age group, smoking was associated with an increased risk of death from any medical cause among both women (risk ratio, 2.0; 99% confidence interval [CI], 1.8 to 2.3) and men (risk ratio, 1.7; 99% CI, 1.6 to 1.8). Daily smoking of even a small amount of tobacco was associated with increased mortality. Excess deaths among smokers, as compared with nonsmokers, were chiefly from tuberculosis among both women (risk ratio, 3.0; 99% CI, 2.4 to 3.9) and men (risk ratio, 2.3; 99% CI, 2.1 to 2.6) and from respiratory, vascular, or neoplastic disease. Smoking was associated with a reduction in median survival of 8 years for women (99% CI, 5 to 11) and 6 years for men (99% CI, 5 to 7). If these associations are mainly causal, smoking in persons between the ages of 30 and 69 years is responsible for about 1 in 20 deaths of women and 1 in 5 deaths of men. In 2010, smoking will cause about 930,000 adult deaths in India; of the dead, about 70% (90,000 women and 580,000 men) will be between the ages of 30 and 69 years. Because of population growth, the absolute number of deaths in this age group is rising by about 3% per year.

Conclusions Smoking causes a large and growing number of premature deaths in India.

Source Information

From the Centre for Global Health Research, Toronto (P.J., B.J., R. Kamadod); and the Epidemiological Research Centre, Chennai (V.G.); Healis-Sekhsaria Institute for Public Health, Mumbai (P.C.G.); the Rural Health Training Centre, Najafgarh, New Delhi (N.D.); the School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh (R. Kumar); the School of Preventative Oncology, Patna (D.N.S.); Tata Memorial Hospital, Mumbai (R.P.D.); and North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong (D.K.P.) — all in India; and the Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, United Kingdom (J.B., R.P.).

This article (10.1056/NEJMsa0707719) was published at www.nejm.org on February 13, 2008. It will appear in the March 13 issue of the Journal.

Address reprint requests to Dr. Jha at the Centre for Global Health Research, St. Michael's Hospital, University of Toronto, Toronto, ON M5C 1N8, Canada, or at prabhat.jha{at}utoronto.ca.

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