India is in the midst of a catastrophic epidemic of smoking deaths, which is expected to cause about one million (10 lakh)* deaths a year during the 2010s -- including one in five of all male deaths and one in 20 of all female deaths at ages 30-69. On average, male bidi smokers lose about six years of life, female bidi smokers lose about eight years and male cigarette smokers lose about ten years.
The findings are from the first nationally representative study of smoking in India as a whole. The research, led by a team from India, Canada and the UK, is published online today (February 13, 2008) in the New England Journal of Medicine.
About 900 field workers surveyed all adult deaths during 2001-2003 in a nationally representative sample of 1.1 million (11 lakh) homes in all parts of India. Researchers compared smoking histories of 74,000 adults who had died with 78,000 living controls.
Among men in the study who died at ages 30-69, smoking caused about:
Lead author Professor Prabhat Jha of the Centre for Global Health Research (CGHR), St. Michael's Hospital, University of Toronto, Canada, said: "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. And, smoking kills not only from diseases like cancer and lung diseases but also from tuberculosis and heart attacks.
In India, there are about 120 million (12 crore) smokers. More than one-third of men and about five per cent of women aged 30-69 smoke either cigarettes or bidis (which contain only about a quarter as much tobacco as a cigarette, wrapped in the leaf of another plant -- temburni).
The study found that, among men, about 61% of those who smoke can expect to die at ages 30-69 compared with only 41% of otherwise similar non-smokers. Among women, 62% of those who smoke can expect to die at ages 30-69 compared with only 38% of non-smokers.
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 smoke risks."
"It is truly remarkable that one single factor, namely smoking, which is entirely preventable, accounts for nearly one in ten of all deaths in India. The study brings out forcefully the need for immediate public action in this much neglected field", states Professor Amartya Sen, Nobel Laureate in Economics, 2001.
The study found there were no safe levels of smoking, but while the hazards of smoking even a few bidis a day were substantial, the dangers of cigarette smoking were even greater, corresponding to more than a doubling of the risk of death in middle age. This suggests that cigarette smokers lose about 10 years of life compared to non-smokers -- risks similar to those seen in the West.
"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."
Summary of key findings:
*Indian and western numbers: 1 lakh=100 thousand, 10 lakh=1 million, 1 crore=10 million
Journal reference: A Nationally Representative Case-Control Study of Smoking and Death in India. New England Journal of Medicine. 358. (10.1056/NEJMsa0707719)
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