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Smoking Will Kill One Million Indians Each Year, Fogarty-Supported Study Says

January - February, 2008  |  Volume 7, Issue 1

India's smoking epidemic is expected to cause one million deaths a year, with more than half of them occurring among the poor and illiterate, according to a recent Fogarty-funded study.

With 120 million Indian smokers, the death toll from tuberculosis, cardiovascular disease, respiratory conditions and cancer could soon account for 20 percent of all male deaths, and five percent of all female deaths in middle age, the study says.

The findings are from the first national study of smoking in India and were published recently in the New England Journal of Medicine. Led by Dr. Prabhat Jha at the University of Toronto, the effort involved about 900 field workers who surveyed 1.1 million homes in all parts of India. Researchers compared the smoking histories of 74,000 adults who had died with 78,000 living controls.

"Fogarty is proud to be a sponsor of this groundbreaking study," said Fogarty Director Dr. Roger I. Glass. "It has been an extraordinary effort to survey over one million homes, but that task looks small compared to the enormous and avoidable toll that smoking will cause among Indian men and women," said Fogarty Director Dr. Roger I. Glass.

More than 30 percent of men and five percent of women aged 30-69 smoke either regular cigarettes or "bidis," small, cheaply made versions containing about one-fourth the amount of tobacco.

Substantial hazards were found among both educated and illiterate adults, in both urban and in rural areas. However, smoking-related deaths are mainly caused by TB in rural areas, while in urban areas deaths are often linked to heart attacks. The study also found smokers in India have twice the cancer rate of non-smokers.

"The extreme risks from smoking that we found surprised us, as smokers in India start at a later age than those in Europe or America and smoke less," said Dr. Jha. "This research demonstrates the scale of the problem."

Men who smoked cigarettes lost an average of ten years of life, while smoking bidis cut an average of six years from life expectancy. The study found there were no safe levels of smoking. While the hazards of smoking even a few bidis a day raised mortality risks by one-third, consuming the same number of cigarettes nearly doubled the risk of death in middle age.

"I am alarmed by the results of this study," said India's Health Minister Dr. Abumani Ramadoss. "The government of India is trying to take all steps to control tobacco use--in particular by informing the many poor and illiterate of smoking risks."

It's clear that the best way for smokers to reduce their risk of these life threatening diseases, is to stop smoking entirely, the researchers concluded. "Smoking kills, but stopping works--about a quarter of all smokers will be killed by tobacco in middle age, unless they stop," said co-author Professor Sir Richard Peto of Oxford University. "British studies show that stopping smoking is remarkably effective."

A Nationally Representative Case-Control Study of Smoking and Death in India, Jha P, Jacob B, Gajalakshmi V, Gupta PC, Dhingra N, Kumar R, Sinha DN, Dikshit RP, Parida DK, Kamadod R, Boreham J, Peto R.

To learn more, visit: http://content.nejm.org/cgi/content/full/NEJMsa0707719

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