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Smokeless tobacco accounts for 250,000 deaths annually worldwide

Smokeless tobacco accounts for more than 6 million disability-adjusted life-years lost and more than a quarter-million deaths each year worldwide, according to an analysis of data from more than 100 countries.

“There is a need to build on the insights obtained from efforts to reduce cigarette smoking-related harm, and to investigate strategies to reduce use of smokeless tobacco and decrease the substantial associated burden of harm,” Kamran Siddiqi, PhD, of the department of health sciences at University of York in the United Kingdom, and colleagues wrote.

Siddiqi and colleagues used the 2010 Global Burden of Disease study to estimate the burden of disability-adjusted life-years (DALY) lost and mortality attributable to smokeless tobacco.

They calculated risk estimates to determine population exposure to smokeless tobacco, with the prevalence of use obtained from the Global Adult Tobacco Survey, World Health Organization STEPwise approach to Surveillance, The Demographic and Health Surveys, or the Special Europe Barometer, when available.

The researchers compiled consumption information from 115 countries, as well as figures on burden of disease from 113 countries.

Results showed that, in 2010, smokeless tobacco accounted for 1.7 million DALYs lost and 62,283 deaths due to cancers of the mouth, pharynx and esophagus. An analysis of 32 studies revealed pooled nonspecific relative risks of 3.43 (95% CI, 2.26-5.19) for mouth cancer, 2.23 (95% CI, 1.55-3.2) for pharynx cancer and 2.17 (95% CI, 1.7-2.78) for esophageal cancer among smokeless tobacco users.

The investigators also determined smokeless tobacco accounted for 4.7 million DALYs lost and 204,309 deaths due to ischemic heart disease. The INTERHEART study, a large case-control study conducted in 52 countries, revealed a statistically significant risk for ischemic heart disease among individuals who use smokeless tobacco (adjusted OR = 1.57; 95% CI, 1.24-1.99). The majority of this burden (> 85%) occurred in Southeast Asia, according to the researchers. – by Jeff Craven

Disclosure: Sheikh reports funding from The Commonwealth Fund outside the submitted work.