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Burden of Total and Cause-Specific Mortality Related to Tobacco Smoking among Adults Aged ≥45 Years in Asia: A Pooled Analysis of 21 Cohorts

Zheng, Wei; McLerran, Dale F.; Rolland, Betsy A.; Fu, Zhenming; Boffetta, Paolo; He, Jiang; Gupta, Prakash Chandra; Ramadas, Kunnambath; Tsugane, Shoichiro; Irie, Fujiko; Tamakoshi, Akiko; Gao, Yu-Tang; Koh, Woon-Puay; Shu, Xiao-Ou; Ozasa, Kotaro; Nishino, Yoshikazu; Tsuji, Ichiro; Tanaka, Hideo; Chen, Chien-Jen; Yuan, Jian-Min; Ahn, Yoon-Ok; Yoo, Keun-Young; Ahsan, Habibul; Pan, Wen-Harn; Qiao, You-Lin; Gu, Dongfeng; Pednekar, Mangesh Suryakant; Sauvaget, Catherine; Sawada, Norie; Sairenchi, Toshimi; Yang, Gong; Wang, Renwei; Xiang, Yong-Bing; Ohishi, Waka; Kakizaki, Masako; Watanabe, Takashi; Oze, Isao; You, San-Lin; Sugawara, Yumi; Butler, Lesley M.; Kim, Dong-Hyun; Park, Sue K.; Parvez, Faruque; Chuang, Shao-Yuan; Fan, Jin-Hu; Shen, Chen-Yang; Chen, Yu; Grant, Eric J.; Lee, Jung Eun; SInha, Rashmi; Matsuo, Keitaro; Thornquist, Mark; Inoue, Manami; Feng, Ziding; Kang, Daehee; Potter, John D.

Background: Tobacco smoking is a major risk factor for many diseases. We sought to quantify the burden of tobacco-smoking-related deaths in Asia, in parts of which men's smoking prevalence is among the world's highest.

Methods and Findings: We performed pooled analyses of data from 1,049,929 participants in 21 cohorts in Asia to quantify the risks of total and cause-specific mortality associated with tobacco smoking using adjusted hazard ratios and their 95% confidence intervals. We then estimated smoking-related deaths among adults aged ≥45 y in 2004 in Bangladesh, India, mainland China, Japan, Republic of Korea, Singapore, and Taiwan—accounting for ∼71% of Asia's total population. An approximately 1.44-fold (95% CI = 1.37–1.51) and 1.48-fold (1.38–1.58) elevated risk of death from any cause was found in male and female ever-smokers, respectively. In 2004, active tobacco smoking accounted for approximately 15.8% (95% CI = 14.3%–17.2%) and 3.3% (2.6%–4.0%) of deaths, respectively, in men and women aged ≥45 y in the seven countries/regions combined, with a total number of estimated deaths of ∼1,575,500 (95% CI = 1,398,000–1,744,700). Among men, approximately 11.4%, 30.5%, and 19.8% of deaths due to cardiovascular diseases, cancer, and respiratory diseases, respectively, were attributable to tobacco smoking. Corresponding proportions for East Asian women were 3.7%, 4.6%, and 1.7%, respectively. The strongest association with tobacco smoking was found for lung cancer: a 3- to 4-fold elevated risk, accounting for 60.5% and 16.7% of lung cancer deaths, respectively, in Asian men and East Asian women aged ≥45 y.

Conclusions: Tobacco smoking is associated with a substantially elevated risk of mortality, accounting for approximately 2 million deaths in adults aged ≥45 y throughout Asia in 2004. It is likely that smoking-related deaths in Asia will continue to rise over the next few decades if no effective smoking control programs are implemented.

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Academic Units
Environmental Health Sciences
Publisher
Public Library of Science
Published Here
October 17, 2016
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