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Prabhat Jha

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... studied and smoker vs nonsmoker death rate ratio (RR) 2.0 ... Smoker vs Nonsmoker. Risk Ratio. Smoking kills all categories of men. results for men aged 30-69 ... – PowerPoint PPT presentation

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Title: Prabhat Jha


1
World Bank seminar, April 2, 2008, Washington, DC
Smoking and Death in India
  • Prabhat Jha
  • On behalf of the RGI-CGHR Investigators
  • Sources of support
  • ICMR and RGI (India) FIC, NIH (US) IDRC CIHR
    (Canada) CTSU, MRC CR-UK (UK)
  • Centre for Global Health Research (CGHR)
  • Keenan Research Centre at the Li Ka Shing
    Knowledge Institute
  • St. Michaels Hospital, University of Toronto
  • prabhat.jha_at_utoronto.ca

2
Key messages for the individual smoker in India
  1. Risk BIGGER than previously thought
  2. Smoking kills EARLY 70 smoking deaths are at
    ages 30-69, losing decades of good life
  3. Even a FEW bidis or cigarettes per day kills
  4. STOPPING SMOKING WORKS but, less than 2 of
    adults in India have quit

3
Nationally representative sample (Sample
Registration System)
  • 6,671 of these small areas randomly chosen from
    all parts of India (each with about 1000 people
    per area)

4
How was the study done?
900 non-medical staff monitored 1.1 M (11 lakh)
homes for three years (2001-3)
2 physicians assigned underlying fatal disease
(eg TB)
All adult deaths from diseases (74,000 deaths)
Obtain smoking history of the dead from living
household members
Compare smoking history of the dead to smoking
history of 78,000 living adults
5
Whats new about this research?
  • Large size of study
  • Nationally representative study of the causes of
    deaths in adults results reflect the whole of
    India
  • First reliable study of female deaths from
    smoking in India

6
Smoking prevalence in India
Cigarette or bidi (less tobacco than a cigarette,
wrapped in the leaf of another plant)
7
Rising prevalence among young men?
Year men age 15-29 years who smoke
1998 9.9
2004 11.8
2006 24.6
Increase 2006 vs 1998 17 M
8
Smoking prevalence by education
9
Smoking prevalence by education
10
Indian Women aged 30-69 No. of deaths studied
and smoker vs nonsmoker death rate ratio (RR)
Underlying fatal disease No. deaths studied who had smoked Smoker vs nonsmoker RR
Tuberculosis 1,363 13 3.0 (2.4-3.9)
Respiratory disease 2,288 14 3.1 (2.5-3.8)
Stroke 1,597 8 1.6 (1.2-2.1)
Heart disease 2,473 7 1.7 (1.3-2.1)
Cancers 2,153 8 2.1 (1.6-2.6)
All diseases 16,386 9 2.0 (1.8-2.3)
versus 4.5 of 26,678 living women who had
smoked Risk ratio adjusted for age, alcohol use
and education
11
Indian Men aged 30-69 No. of deaths studied and
smoker vs nonsmoker death rate ratio (RR)
Underlying fatal disease No. deaths studied who had smoked Smoker vs nonsmoker RR
Tuberculosis 3,119 66 2.3 (2.1-2.6)
Respiratory disease 3,487 60 2.1 (1.9-2.3)
Stroke 2,200 53 1.6 (1.4-1.8)
Heart disease 5,409 52 1.6 (1.5-1.8)
Cancers 2,248 59 2.1 (1.9-2.4)
All diseases 25,290 55 1.7 (1.6-1.8)
versus 37.0 of 31,661 living men who had
smoked Risk ratio adjusted for age, alcohol use
and education
12
Smoking kills all categories of men results for
men aged 30-69
Category Smokers () Risk Ratio
Residence
Rural 56.4 1.6 (1.6-1.8)
Urban 51.3 1.9 (1.6-2.1)
Education
None 58.2 1.6 (1.5-1.7)
Primary 56.8 1.7 (1.5-1.8)
Secondary 47.8 1.7 (1.6-1.9)
Alcohol
No 44.0 1.6 (1.5-1.7)
Yes 75.7 1.6 (1.5-1.8)

Total 55.4 1.7 (1.6-1.8)
Smoker vs Nonsmoker Risk Ratio
adjusted for age, alcohol use and education
13
Any smoking kills
adjusted for age, alcohol use and education
14
Cumulative risk of death, from age 30 smokers vs
nonsmokers
Women
adjusted for age, alcohol use and education
15
Cumulative risk of death, from age 30 smokers vs
nonsmokers
Men
adjusted for age, alcohol use and education
16
Disease-specific risks of death, ages
30-69smokers vs nonsmokers
Women
risk in the absence of other causes of death,
adjusted for age, alcohol use and education
17
Disease-specific risks of death, ages 30-69
smokers vs nonsmokers
Men
risk in the absence of other causes of death,
adjusted for age, alcohol use and education
18
Deaths from smoking in year 2010 in India, ages
30-69, by disease
Disease Women Total deaths 2.0 M Women Total deaths 2.0 M Men Total deaths2.9 M Men Total deaths2.9 M Men Total deaths2.9 M
Disease No. ( all deaths) No. ( all deaths) ( all deaths)
Respiratory disease 26,000 10 109,000 109,000 31
Tuberculosis 14,000 9 120,000 120,000 38
Heart disease/stroke 13,000 3 152,000 152,000 20
Cancer 9,000 4 67,000 67,000 32
TOTAL, all diseases 93,000 5 579,000 579,000 20
19
Deaths from smoking in year 2010 in India
Age range Women Men Both
Ages 30-69 93,000 579,000 672,000
All adults 20 128,000 807,000 935,000
Annual deaths from smoking will rise from
930,000 to 1,000,000 (10 lakh) during 2010s
20
Low quit rates in India, 2004
Region Ex-smoking age 30 Women Men Ex-smoking age 30 Women Men
India 0.2 1.9
Kerala 1.1 7.1
Delhi 0.05 0.8
highest and lowest male quit rates,
respectively
21
INDIA 1 million (10 lakh) smoking deaths per
year during 2010s
  • Smoking causes 10 of the 10 million (1 crore)
    deaths per year from all fatal disease
  • 70 of smoking deaths are in middle age
    (30-69) 700,000 (7 lakh) 600,000 men and
    100,000 women
  • 20 of all adult male deaths and 5 of all adult
    female deaths in middle age
  • Over 50 of smoking deaths are in illiterate
    adults

22
Key messages for the individual smoker in India
  1. Risk BIGGER than previously thought
  2. Smoking kills EARLY 70 smoking deaths are at
    ages 30-69, losing decades of good life
  3. Even a FEW bidis or cigarettes per day kills
  4. STOPPING SMOKING WORKS but, less than 2 of
    adults in India have quit

23
Press materials on www.cghr.org/tobacco
  1. NEJM Paper and Supplementary Appendix
  2. Press and video releases English, Hindi and
    regional languages
  3. Frequently-asked questions
  4. PowerPoint slides in English
  5. Information about CGHR and partners

News coverage of paper at http//youtube.com/watc
h?v9COgO6cXwY4 http//youtube.com/watch?vuH66GQA
DiEs
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