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Bull World Health Organ. 2015 Oct 1;93(10):684-692. Epub 2015 Jun 25.

Betel quid use and mortality in Bangladesh: a cohort study.

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Department of Population Health, New York University School of Medicine, 650 First Avenue, New York, NY 10016, United States of America (USA).
Department of Environmental Health Sciences, Columbia University, New York, USA .
U-Chicago Research Bangladesh Ltd., Dhaka, Bangladesh .
Department of Health Studies, University of Chicago, Chicago, USA .


in English, Arabic, Chinese, French, Russian, Spanish


To evaluate the potential effects of betel quid chewing on mortality. (A quid consists of betel nut, wrapped in betel leaves; tobacco is added to the quid by some users).


Prospective data were available on 20 033 individuals aged 18-75 years, living in Araihazar, Bangladesh. Demographic and exposure data were collected at baseline using a standardized questionnaire. Cause of death was defined by verbal autopsy questionnaires administered to next of kin. We estimated hazard ratios (HR) and their 95% confidence intervals (CI) for associations between betel use and mortality from all causes and from specific causes, using Cox proportional hazards models. We adjusted for age, sex, body mass index, educational attainment and tobacco smoking history.


There were 1072 deaths during an average of 10 years of follow-up. Participants who had ever used betel were significantly more likely to die from all causes (HR: 1.26; 95% CI: 1.09-1.44) and cancer (HR: 1.55; 95% CI: 1.09-2.22); but not cardiovascular disease (HR: 1.16; 95% CI: 0.93-1.43). These findings were robust to adjustment for potential confounders. There was a dose-response relationship between mortality from all causes and both the duration and the intensity of betel use. The population attributable fraction for betel use was 14.1% for deaths from all causes and 24.2% for cancer.


Betel quid use was associated with mortality from all causes and from cancer in this cohort.

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