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PLoS Med. 2014 Apr 22;11(4):e1001631. doi: 10.1371/journal.pmed.1001631. eCollection 2014.

Burden of total and cause-specific mortality related to tobacco smoking among adults aged ≥ 45 years in Asia: a pooled analysis of 21 cohorts.

Author information

  • 1Division of Epidemiology, Department of Medicine, Vanderbilt University, Nashville, Tennessee, United States of America; Vanderbilt Epidemiology Center, Vanderbilt University, Nashville, Tennessee, United States of America; Vanderbilt-Ingram Cancer Center, Vanderbilt University, Nashville, Tennessee, United States of America.
  • 2Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America.
  • 3Division of Epidemiology, Department of Medicine, Vanderbilt University, Nashville, Tennessee, United States of America; Vanderbilt Epidemiology Center, Vanderbilt University, Nashville, Tennessee, United States of America; Vanderbilt-Ingram Cancer Center, Vanderbilt University, Nashville, Tennessee, United States of America; Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan, China.
  • 4The Tisch Cancer Institute, Ichan School of Medicine at Mount Sinai, New York, New York, United States of America; International Prevention Research Institute, Lyon, France.
  • 5Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States of America.
  • 6Healis-Sekhsaria Institute for Public Health, Navi Mumbai, India.
  • 7Division of Radiation Oncology, Regional Cancer Center, Medical College Campus, Trivandrum, India.
  • 8Epidemiology and Prevention Division, Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo, Japan.
  • 9Department of Health and Social Services, Ibaraki Prefectural Government, Ibaraki, Japan.
  • 10Department of Public Health, Aichi Medical University School of Medicine, Aichi, Japan.
  • 11Department of Epidemiology, Shanghai Cancer Institute, Shanghai, China.
  • 12Duke-National University of Singapore Graduate Medical School, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
  • 13Radiation Effects Research Foundation, Hiroshima, Japan.
  • 14Division of Epidemiology, Miyagi Cancer Center Research Institute, Natori, Japan.
  • 15Tohoku University Graduate School of Medicine, Sendai, Japan.
  • 16Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Japan.
  • 17Genomics Research Center, Academia Sinica, Taipei, Taiwan; Graduate Institute of Epidemiology, College of Public Health, National Taiwan University, Taipei, Taiwan.
  • 18Division of Cancer Control and Population Sciences, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania, United States of America; Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America.
  • 19Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
  • 20Department of Health Studies, University of Chicago, Chicago, Illinois, United States of America; Department of Medicine, University of Chicago, Chicago, Illinois, United States of America; Department of Human Genetics, University of Chicago, Chicago, Illinois, United States of America; University of Chicago Cancer Research Center, University of Chicago, Chicago, Illinois, United States of America.
  • 21Graduate Institute of Epidemiology, College of Public Health, National Taiwan University, Taipei, Taiwan; Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan; Department of Biochemical Science and Technology, National Taiwan University, Taipei, Taiwan.
  • 22Department of Cancer Epidemiology, Cancer Institute/Hospital, Chinese Academy of Medical Sciences, Beijing, China.
  • 23Fuwai Hospital and Cardiovascular Institute, Chinese Academy of Medical Sciences, Beijing, China; China National Center for Cardiovascular Disease, Beijing, China.
  • 24Screening Group, Prevention and Early Detection Section, International Agency for Research on Cancer, Lyon, France.
  • 25Department of Public Health, Dokkyo Medical University School of Medicine, Tochigi, Japan.
  • 26Department of Medical Oncology and Immunology, Nagoya City University Graduate School of Medical Science, Nagoya, Japan.
  • 27Genomics Research Center, Academia Sinica, Taipei, Taiwan.
  • 28Department of Social and Preventive Medicine, Hallym University College of Medicine, Okcheon-dong, Republic of Korea.
  • 29Department of Preventive Medicine, Seoul National University College of Medicine, Seoul National University, Seoul, Republic of Korea.
  • 30Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, New York, United States of America.
  • 31Division of Preventive Medicine and Health Services Research, Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan.
  • 32Taiwan Biobank, Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan; Graduate Institute of Environmental Science, China Medical University, Taichung, Taiwan.
  • 33Department of Environmental Medicine, New York University School of Medicine, New York, New York, United States of America.
  • 34Department of Food and Nutrition, Sookmyung Women's University, Seoul, Republic of Korea.
  • 35Nutritional Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Rockville, Maryland, United States of America.
  • 36Graduate School of Medicine, University of Tokyo, Tokyo, Japan; Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo, Japan.
  • 37Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America.

Abstract

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. Please see later in the article for the Editors' Summary.

PMID:
24756146
[PubMed - indexed for MEDLINE]
PMCID:
PMC3995657
Free PMC Article
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